Control of sexually transmitted diseases for AIDS prevention in Uganda

A randomised community trial

Maria J Wawer, Nelson K. Sewankambo, David Serwadda, Thomas C Quinn, Lynn A. Paxton, Noah Kiwanuka, Fred Wabwire-Mangen, Chuanjun Li, Thomas Lutalo, Fred Nalugoda, Charlotte A Gaydos, Lawrence Hale Moulton, Mary O. Meehan, Saifuddin Ahmed, Ronald H Gray

Research output: Contribution to journalArticle

Abstract

Background. The study tested the hypothesis that community-level control of sexually transmitted disease (STD) would result in lower incidence of HIV-1 infection in comparison with control communities. Methods. This randomised, controlled, single-masked, community-based trial of intensive STD control, via home-based mass antibiotic treatment, took place in Rakai District, Uganda. Ten community clusters were randomly assigned to intervention or control groups. All consenting residents aged 15-59 years were enrolled; visited in the home every 10 months; interviewed; asked to provide biological samples for assessment of HIV-1 infection and STDs; and were provided with mass treatment (azithromycin, ciprofloxacin, metronidazole in the intervention group, vitamins/anthelmintic drug in the control). Intention-to-treat analyses used multivariate, paired, cluster-adjusted rate ratios. Findings. The baseline prevalence of HIV-1 infection was 15.9%, 6602 HIV-1-negative individuals were enrolled in the intervention group and 6124 in the control group, 75.0% of intervention-group and 72.6% of control-group participants provided at least one follow-up sample for HIV-1 testing. At enrolment, the two treatment groups were similar in STD prevalence rates. At 20-month follow-up, the prevalences of syphilis (352/6238 [5.6%) vs 359/5284 [6.8%]; rate ratio 0.80 [95% CI 0.71-0.89]) and trichomoniasis (182/1968 [9.3%] vs 261/1815 [14.4%]; rate ratio 0.59 [0.38-0.91]) were significantly lower in the intervention group than in the control group. The incidence of HIV-1 infection was 1.5 per 100 person-years in both groups (rate ratio 0.97 [0.81-1.16]). In pregnant women, the follow-up prevalences of trichomoniasis, bacterial vaginosis, gonorrhoea, and chlamydia infection were significantly lower in the intervention group than in the control group. No effect of the intervention on incidence of HIV-1 infection was observed in pregnant women or in stratified analyses. Interpretation. We observed no effect of the STD intervention on the incidence of HIV-1 infection. In the Rakai population, a substantial proportion of HIV-1 acquisition appears to occur independently of treatable STD cofactors.

Original languageEnglish (US)
Pages (from-to)525-535
Number of pages11
JournalThe Lancet
Volume353
Issue number9152
DOIs
StatePublished - Feb 13 1999
Externally publishedYes

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Uganda
Sexually Transmitted Diseases
HIV-1
Acquired Immunodeficiency Syndrome
HIV Infections
Control Groups
Incidence
Pregnant Women
Bacterial Vaginosis
Chlamydia Infections
Azithromycin
Intention to Treat Analysis
Anthelmintics
Gonorrhea
Drug and Narcotic Control
Metronidazole
Syphilis
Ciprofloxacin
Vitamins
Therapeutics

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Control of sexually transmitted diseases for AIDS prevention in Uganda : A randomised community trial. / Wawer, Maria J; Sewankambo, Nelson K.; Serwadda, David; Quinn, Thomas C; Paxton, Lynn A.; Kiwanuka, Noah; Wabwire-Mangen, Fred; Li, Chuanjun; Lutalo, Thomas; Nalugoda, Fred; Gaydos, Charlotte A; Moulton, Lawrence Hale; Meehan, Mary O.; Ahmed, Saifuddin; Gray, Ronald H.

In: The Lancet, Vol. 353, No. 9152, 13.02.1999, p. 525-535.

Research output: Contribution to journalArticle

Wawer, MJ, Sewankambo, NK, Serwadda, D, Quinn, TC, Paxton, LA, Kiwanuka, N, Wabwire-Mangen, F, Li, C, Lutalo, T, Nalugoda, F, Gaydos, CA, Moulton, LH, Meehan, MO, Ahmed, S & Gray, RH 1999, 'Control of sexually transmitted diseases for AIDS prevention in Uganda: A randomised community trial', The Lancet, vol. 353, no. 9152, pp. 525-535. https://doi.org/10.1016/S0140-6736(98)06439-3
Wawer, Maria J ; Sewankambo, Nelson K. ; Serwadda, David ; Quinn, Thomas C ; Paxton, Lynn A. ; Kiwanuka, Noah ; Wabwire-Mangen, Fred ; Li, Chuanjun ; Lutalo, Thomas ; Nalugoda, Fred ; Gaydos, Charlotte A ; Moulton, Lawrence Hale ; Meehan, Mary O. ; Ahmed, Saifuddin ; Gray, Ronald H. / Control of sexually transmitted diseases for AIDS prevention in Uganda : A randomised community trial. In: The Lancet. 1999 ; Vol. 353, No. 9152. pp. 525-535.
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T1 - Control of sexually transmitted diseases for AIDS prevention in Uganda

T2 - A randomised community trial

AU - Wawer, Maria J

AU - Sewankambo, Nelson K.

AU - Serwadda, David

AU - Quinn, Thomas C

AU - Paxton, Lynn A.

AU - Kiwanuka, Noah

AU - Wabwire-Mangen, Fred

AU - Li, Chuanjun

AU - Lutalo, Thomas

AU - Nalugoda, Fred

AU - Gaydos, Charlotte A

AU - Moulton, Lawrence Hale

AU - Meehan, Mary O.

AU - Ahmed, Saifuddin

AU - Gray, Ronald H

PY - 1999/2/13

Y1 - 1999/2/13

N2 - Background. The study tested the hypothesis that community-level control of sexually transmitted disease (STD) would result in lower incidence of HIV-1 infection in comparison with control communities. Methods. This randomised, controlled, single-masked, community-based trial of intensive STD control, via home-based mass antibiotic treatment, took place in Rakai District, Uganda. Ten community clusters were randomly assigned to intervention or control groups. All consenting residents aged 15-59 years were enrolled; visited in the home every 10 months; interviewed; asked to provide biological samples for assessment of HIV-1 infection and STDs; and were provided with mass treatment (azithromycin, ciprofloxacin, metronidazole in the intervention group, vitamins/anthelmintic drug in the control). Intention-to-treat analyses used multivariate, paired, cluster-adjusted rate ratios. Findings. The baseline prevalence of HIV-1 infection was 15.9%, 6602 HIV-1-negative individuals were enrolled in the intervention group and 6124 in the control group, 75.0% of intervention-group and 72.6% of control-group participants provided at least one follow-up sample for HIV-1 testing. At enrolment, the two treatment groups were similar in STD prevalence rates. At 20-month follow-up, the prevalences of syphilis (352/6238 [5.6%) vs 359/5284 [6.8%]; rate ratio 0.80 [95% CI 0.71-0.89]) and trichomoniasis (182/1968 [9.3%] vs 261/1815 [14.4%]; rate ratio 0.59 [0.38-0.91]) were significantly lower in the intervention group than in the control group. The incidence of HIV-1 infection was 1.5 per 100 person-years in both groups (rate ratio 0.97 [0.81-1.16]). In pregnant women, the follow-up prevalences of trichomoniasis, bacterial vaginosis, gonorrhoea, and chlamydia infection were significantly lower in the intervention group than in the control group. No effect of the intervention on incidence of HIV-1 infection was observed in pregnant women or in stratified analyses. Interpretation. We observed no effect of the STD intervention on the incidence of HIV-1 infection. In the Rakai population, a substantial proportion of HIV-1 acquisition appears to occur independently of treatable STD cofactors.

AB - Background. The study tested the hypothesis that community-level control of sexually transmitted disease (STD) would result in lower incidence of HIV-1 infection in comparison with control communities. Methods. This randomised, controlled, single-masked, community-based trial of intensive STD control, via home-based mass antibiotic treatment, took place in Rakai District, Uganda. Ten community clusters were randomly assigned to intervention or control groups. All consenting residents aged 15-59 years were enrolled; visited in the home every 10 months; interviewed; asked to provide biological samples for assessment of HIV-1 infection and STDs; and were provided with mass treatment (azithromycin, ciprofloxacin, metronidazole in the intervention group, vitamins/anthelmintic drug in the control). Intention-to-treat analyses used multivariate, paired, cluster-adjusted rate ratios. Findings. The baseline prevalence of HIV-1 infection was 15.9%, 6602 HIV-1-negative individuals were enrolled in the intervention group and 6124 in the control group, 75.0% of intervention-group and 72.6% of control-group participants provided at least one follow-up sample for HIV-1 testing. At enrolment, the two treatment groups were similar in STD prevalence rates. At 20-month follow-up, the prevalences of syphilis (352/6238 [5.6%) vs 359/5284 [6.8%]; rate ratio 0.80 [95% CI 0.71-0.89]) and trichomoniasis (182/1968 [9.3%] vs 261/1815 [14.4%]; rate ratio 0.59 [0.38-0.91]) were significantly lower in the intervention group than in the control group. The incidence of HIV-1 infection was 1.5 per 100 person-years in both groups (rate ratio 0.97 [0.81-1.16]). In pregnant women, the follow-up prevalences of trichomoniasis, bacterial vaginosis, gonorrhoea, and chlamydia infection were significantly lower in the intervention group than in the control group. No effect of the intervention on incidence of HIV-1 infection was observed in pregnant women or in stratified analyses. Interpretation. We observed no effect of the STD intervention on the incidence of HIV-1 infection. In the Rakai population, a substantial proportion of HIV-1 acquisition appears to occur independently of treatable STD cofactors.

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