Sexually transmitted infection screening, prevalence and incidence among South African men and transgender women who have sex with men enrolled in a combination HIV prevention cohort study : the Sibanye Methods for Prevention Packages Programme (MP3) project

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Authors

Jones, Jeb
Sanchez, Travis H.
Dominguez, Karen
Bekker, Linda-Gail
Phaswana-Mafuya, Nancy
Baral, Stefan D.
McNaghten, A.D.
Kgatitswe, Lesego B.
Valencia, Rachel
Yah, Clarence S.

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BioMed Central

Abstract

INTRODUCTION : Men who have sex with men (MSM) and transgender women (TGW) experience high incidence and prevalence of sexually transmitted infections (STI), and data are needed to understand risk factors for STIs in these populations. The Sibanye Health Project was conducted in Cape Town and Port Elizabeth, South Africa from 2015 to 2016 to develop and test a package of HIV prevention interventions for MSM and TGW. We describe the incidence, prevalence and symptoms of Chlamydia trachomatis (CT), Neisseria gonorrhea (NG) and syphilis observed during the study. METHODS : Participants completed HIV testing at baseline. All participants who were HIV negative were followed prospectively. Additionally, a sample of participants identified as living with HIV at baseline was selected to be followed prospectively so that the prospective cohort was approximately 20% HIV positive; the remaining participants identified as HIV positive at baseline were not followed prospectively. Prospective participants were followed for 12 months and returned for clinic-based STI/HIV testing and assessment of STI symptoms at months 6 and 12. Additional HIV/STI testing visits could be scheduled at participant request. RESULTS : Following consent, a total of 292 participants attended a baseline visit (mean age = 26 years), and 201 were enrolled for the 12-month prospective study. Acceptance of screening for syphilis and urethral NG/CT was near universal, though acceptance of screening for rectal NG/CT was lower (194/292; 66%). Prevalence of urethral CT and NG at baseline was 10% (29/289) and 3% (8/288) respectively; incidence of urethral CT and NG was 12.8/100 person-years (PY) and 7.1/100 PY respectively. Prevalence of rectal CT and NG at baseline was 25% (47/189) and 16% (30/189) respectively; incidence of rectal CT and NG was 33.4/100 PY and 26.8/100 PY respectively. Prevalence of syphilis at baseline was 17% (45/258) and incidence was 8.2/100 PY. 91%, 95% and 97% of diagnosed rectal NG/CT, urethral NG/CT and syphilis infections, respectively, were clinically asymptomatic. CONCLUSIONS : Prevalence and incidence of urethral and rectal STIs were high among these South African MSM and TGW, and were similar to rates in other settings in the world. Clinical symptoms from these infections were rare, highlighting limitations of syndromic surveillance and suggesting the need for presumptive testing and/or treatment to address the STI epidemic among MSM/TGW in South Africa.

Description

TABLE S1. Acceptance of urethral and syphilis STI screening at baseline and over 12 months of follow-up among men who have sex with men and transgender women in Cape Town and Port Elizabeth, South Africa.
TABLE S2. Rate (per 100 person years), unadjusted rate ratios (RR), and 95% confidence intervals of urethral and rectal chlamydia, urethral and rectal gonorrhea, and syphilis among men who have sex with men (MSM) in Cape Town and Port Elizabeth, South Africa.

Keywords

Gonorrhoea, Syphilis, STI testing, STI incidence, Sexually transmitted infection (STI), Chlamydia, Gonorrhoea, Syphilis, Men who have sex with men (MSM), Transgender women (TGW), Sexually transmitted infection (STI), Human immunodeficiency virus (HIV), Chlamydia trachomatis (CT), Neisseria gonorrhea (NG)

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Citation

Jones, J., Sanchez, T.H., Dominguez, K. et al. 2020, 'Sexually transmitted infection screening, prevalence and incidence among South African men and transgender women who have sex with men enrolled in a combination HIV prevention cohort study : the Sibanye Methods for Prevention Packages Programme (MP3) project', Journal of the International AIDS Society, vol. 23, art. e25594, pp. 1-13.