Showing papers by "Deborah Watson-Jones published in 2009"

Bacterial vaginosis in female facility workers in north-western Tanzania: prevalence and risk factors

Abstract: Objectives: To determine prevalence of, and risk factors for, bacterial vaginosis (BV) among herpes simplex virus (HSV) 2 seropositive Tanzanian women at enrolment into a randomised, placebo-controlled trial of HSV suppressive treatment. Methods: 1305 HSV-2 seropositive women aged 16–35 years working in bars, guesthouses and similar facilities were interviewed, examined and tested for HIV, syphilis, Neisseria gonorrhoeae, Chlamydia trachomatis, BV, candidiasis and trichomoniasis. Factors associated with BV were analysed using logistic regression to estimate odds ratios and 95% confidence intervals. Results: BV prevalence was 62.9%; prevalence of Nugent score 9–10 was 16.1%. Independent risk factors for BV were work facility type, fewer dependents, increasing alcohol consumption, sex in the last week (adjusted OR 2.03; 95% CI 1.57 to 2.62), using cloths or cotton wool for menstrual hygiene, HIV (adjusted OR 1.41; 95% CI 1.09 to 1.83) and Trichomonas vaginalis infection. There was no association between BV and the frequency or method of vaginal cleansing. However, BV was less prevalent among women who reported inserting substances to dry the vagina for sex (adjusted OR 0.44; 95% CI 0.25 to 0.75). Conclusion: BV was extremely prevalent among our study population of HSV-2 positive female facility workers in North-western Tanzania. Although recent sex was associated with increased BV prevalence, vaginal drying was associated with lower BV prevalence. Further studies of the effects of specific practices on vaginal flora are warranted.

Risk factors for HIV incidence in women participating in an HSV suppressive treatment trial in Tanzania

Abstract: OBJECTIVES: A randomized double-blind placebo-controlled trial (RCT) of herpes simplex virus type 2 suppressive therapy with acyclovir 400 mg twice daily conducted among women in northwestern Tanzania reported a similar rate of HIV acquisition in both trial arms (Current Controlled Trials number ISRCTN35385041). Risk factors for HIV incidence were examined in the context of 3-monthly follow-up visits offering both voluntary counselling and testing and care for sexually transmitted infections. DESIGN: Prospective cohort analysis of trial participants enrolled and followed for up to 30 months. METHODS: Risk factors for HIV acquisition were analysed using Cox regression. RESULTS: Overall 821 herpes simplex virus type 2 seropositive HIV seronegative women were randomized; 400 randomized to acyclovir and 421 to placebo; 659 (80.3%) completed follow-up. HIV incidence was 4.27 per 100 person-years. There was no overall impact of acyclovir on HIV incidence [hazard ratio = 1.01; 95% confidence interval (CI) 0.61-1.66]. HIV acquisition was independently associated with younger age at enrolment (age 16-19 vs. 30-35: hazard ratio = 4.02; 95% CI 1.67-9.68) alcohol consumption at enrolment (> or =30 drinks/week vs. none: hazard ratio = 4.39 95% CI 1.70-11.33) having paid sex within the previous 3 months (hazard ratio = 1.82 95% CI 1.09-3.05) recent infection with gonorrhoea (hazard ratio = 3.62 95% CI 1.62-8.08) and injections in the previous 3 months (hazard ratio = 3.45 95% CI 1.62-7.34). There was some evidence of an association between HIV incidence and living in the recruitment community for less than 2 years (hazard ratio = 1.75 95% CI 0.98-3.10) and exposure to hormonal contraception (hazard ratio = 1.60 95% CI 0.93-2.76). CONCLUSION: A high incidence of HIV was observed in this trial cohort especially in young women. Interventions are needed to address the risk associated with alcohol use and to sustain control of other sexually transmitted infections.

Suitability of Simple Human Immunodeficiency Virus Rapid Tests in Clinical Trials in Community-Based Clinic Settings

Abstract: The suitability and accuracy of using simple human immunodeficiency virus (HIV) rapid (SR) tests in community-based clinics in northwest Tanzania were determined to assess eligibility for participation in clinical trials. The HIV rapid and ELISA test results for 789 women aged 16 to 54 who were screened for two clinical trials of HIV prevention were compared. Women were offered voluntary HIV counseling and testing (VCT) at screening; those who accepted were tested with the Abbott Determine and Trinity Biotech Capillus SR tests in parallel. The results were confirmed by two parallel HIV enzyme-linked immunosorbent assay (ELISA) tests (Abbott Murex HIV Ag/Ab combination and Vironostika Uniform II HIV Ag/Ab) to determine eligibility. Positive samples for any of the four assays were confirmed by a line immunoassay and p24 testing. The parallel SR tests had high concordance (96.2%) with the parallel ELISA algorithm. The sensitivities of the SR tests were 98.6% for Capillus (95% confidence interval [CI], 95.1 to 99.8%), 99.3% for Determine (95% CI, 96.2 to 100%), and 98.6% for the parallel SR (95% CI, 95.1 to 99.8%). The specificities were 99.7% for Capillus (95% CI, 98.9 to 100%), 99.7% for Determine (95% CI, 98.9 to 100%), and 100% for the parallel SR (95% CI, 99.4 to 100%). SR tests are suitable for use in community-based clinical research settings to assess eligibility both for trial participation and for the provision of on-site VCT services.

Association between intravaginal practices and HIV acquisition in women: individual patient data meta-analysis of cohort studies in sub-Saharan Africa

Abstract: Background: It is still not clear whether practices such as internal (intravaginal) cleansing and practices used around sexual intercourse, increase women's risk of acquiring HIV infection. Individual studies lack statistical power and direct comparison between studies is hampered by variation in exposure definitions and statistical methods. Methods: A systematic review identified 14 cohort studies in sub-Saharan Africa that measured HIV as an outcome and collected data on vaginal practices; 11 provided individual patient data, and 9 have been analysed to date. We recoded data using standardised definitions of any vaginal practice, intravaginal cleansing, insertion of solid products, and use of products to dry or tighten the vagina. We used univariable Cox proportional hazards models, stratified by study, to examine the association between the use of practices as reported at study baseline and HIV acquisition. Results: A total of 14,766 women contributed 24,587 woman years, with 798 newly-acquired HIV infections. The prevalence of any vaginal practice across cohorts ranged from 18% to 95% (median 76%); intravaginal cleansing was reported by a median of 70% of women (range 7-94%). In univariable analysis, women reporting any vaginal practice had a 1.27 fold higher rate of HIV acquisition (95%CI 0.91-1.77) than never-users, with moderate between-study heterogeneity (I246%). Compared with never-users, hazard ratios for incident HIV in women with different practices were: water only, 1.07 (95%CI 0.83-1.38); other products for intravaginal cleansing, 1.44 (95%CI 1.16-1.79); and practices other than intravaginal cleansing, 1.88 (95%CI 1.25-2.82) Conclusions: Intravaginal practices are common in sub-Saharan Africa. These may increase women's risk of acquiring HIV, particularly practices other than cleansing with water. Additional analyses will clarify the role of confounding in these associations. Common practices that increase HIV risk may also reduce the effectiveness of vaginal microbicides. Interventions to alter potentially harmful intravaginal practices might contribute to combination HIV prevention.