TY - JOUR
T1 - Control of sexually transmitted diseases for HIV-1 prevention
T2 - Understanding the implications of the Mwanza and Rakai trials
AU - Grosskurth, Heiner
AU - Gray, Ronald
AU - Hayes, Richard
AU - Mabey, David
AU - Wawer, Maria
PY - 2000/6/3
Y1 - 2000/6/3
N2 - Two randomised controlled trials of sexually transmitted disease (STD) treatment for the prevention of HIV-1 infection, in Mwanza, Tanzania, and Rakai, Uganda, unexpectedly produced contrasting results. A decrease in population HIV-1 incidence was associated with improved STD case management in Mwanza, but was not associated with STD mass treatment in Rakai. Some reductions in curable STDs were seen in both studies. These trials tested different interventions in different HIV-1 epidemic settings and used different evaluation methods; the divergent results may be complementary rather than contradictory. Possible explanations include: differences in stage of the HIV-1 epidemic, which can influence exposure to HIV-1 and the distribution of viral load in the infected population; potential differences in the prevalence of incurable STDs (such as genital herpes); perhaps greater importance of symptomatic than symptomless STDs for HIV-1 transmission; and possibly greater effectiveness of continuously available services than of intermittent mass treatment to control rapid STD reinfection. Implications of the trials for policy and future research agenda are discussed.
AB - Two randomised controlled trials of sexually transmitted disease (STD) treatment for the prevention of HIV-1 infection, in Mwanza, Tanzania, and Rakai, Uganda, unexpectedly produced contrasting results. A decrease in population HIV-1 incidence was associated with improved STD case management in Mwanza, but was not associated with STD mass treatment in Rakai. Some reductions in curable STDs were seen in both studies. These trials tested different interventions in different HIV-1 epidemic settings and used different evaluation methods; the divergent results may be complementary rather than contradictory. Possible explanations include: differences in stage of the HIV-1 epidemic, which can influence exposure to HIV-1 and the distribution of viral load in the infected population; potential differences in the prevalence of incurable STDs (such as genital herpes); perhaps greater importance of symptomatic than symptomless STDs for HIV-1 transmission; and possibly greater effectiveness of continuously available services than of intermittent mass treatment to control rapid STD reinfection. Implications of the trials for policy and future research agenda are discussed.
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U2 - 10.1016/S0140-6736(00)02336-9
DO - 10.1016/S0140-6736(00)02336-9
M3 - Review article
C2 - 10859054
AN - SCOPUS:0034600451
VL - 355
SP - 1981
EP - 1987
JO - The Lancet
JF - The Lancet
SN - 0140-6736
IS - 9219
ER -