Prevention of sexually transmitted infections in urban communities (Peru PREVEN): a multicomponent community-randomised controlled trial
Prevention of sexually transmitted infections in urban communities (Peru PREVEN): a multicomponent community-randomised controlled trial
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DOI：
10.1016/s0140-6736(11)61846-1
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发表时间：
2012-03-24
期刊：
影响因子：
168.9
通讯作者：
Whittington, William L. H.
中科院分区：
文献类型：
--
作者：
Garcia, Patricia J.;Holmes, King K.;Whittington, William L. H.
背景以前社区随机试验控制性传播感染(STI)的干预措施涉及农村环境，很少是多成分的，结果各不相同。目的评价多因素干预对城市青壮年和女性性工作者(FSWs)可治愈性传播感染的影响。方法在2002年8月至11月期间，在秘鲁人口超过5万的城市中，对18-29岁的青壮年和FSWs进行基线STI筛查。选择地理上不同的城市，将其配对，并随机分配到干预组或对照组，采用S+计划。分别在2年和3年后对随机抽样进行跟踪调查。干预措施包括四种方式：加强药房工作人员和临床医生对性传播感染综合征的管理；流动小组向暗娼进行性传播感染筛查和病原体特异性治疗；定期对暗娼进行滴虫病推定治疗；向暗娼和普通人群推广避孕套。控制城市的个人得到了标准的护理。复合主要终点是年轻人感染沙眼衣原体、阴道毛滴虫、淋病奈瑟菌或梅毒血清反应。实验室工作人员和数据分析师戴着面具，但现场工作人员、秘鲁研究团队和结果调查的参与者没有戴面具。所有分析均按意向处理进行。这项试验的注册号是ISRCTN43722548。我们对秘鲁24个城市的15 261名年轻人进行了基线调查。其中，20个地理上不同的城市被配对，每个城市一个被分配到干预，另一个被分配到标准护理。在2006年的后续调查中，获得了12930名年轻人的综合初步结果数据。我们报告说，与对照城市相比，干预城市年轻人的性传播感染患病率(相对危险度0.84，95%可信区间0-69-1.02；p=0.096)没有显著降低。在亚组分析中，干预城市的年轻成年女性和暗娼的发病率显著下降。对性传播感染的解释综合征管理、流动小组对暗娼的外展、暗娼中滴虫病的推定治疗和避孕套的推广可能会降低本试验中调查的四种可治愈的性传播感染的综合患病率。
Background Previous community-randomised trials of interventions to control sexually transmitted infections (STIs) have involved rural settings, were rarely multicomponent, and had varying results. We aimed to assess the effect of a multicomponent intervention on curable STIs in urban young adults and female sex workers (FSWs).Methods In this community-randomised trial, baseline STI screening was done between August, and November, 2002, in random household samples of young adults (aged 18-29 years) and in FSWs in Peruvian cities with more than 50 000 inhabitants. Geographically separate cities were selected, matched into pairs, and randomly allocated to intervention or control groups with an S-PLUS program. Follow-up surveys of random samples were done after 2 years and 3 years. The intervention comprised four modalities: strengthened STI syndromic management by pharmacy workers and clinicians; mobile-team outreach to FSWs for STI screening and pathogen-specific treatment; periodic presumptive treatment of FSWs for trichomoniasis; and condom promotion for FSWs and the general population. Individuals in control cities received standard care. The composite primary endpoint was infection of young adults with Chlamydia trachomatis, Trichomonas vaginalis, or Neisseria gonorrhoeae, or syphilis seroreactivity. Laboratory workers and the data analyst were masked, but fieldworkers, the Peruvian study team, and participants in the outcome surveys were not. All analyses were done by intention to treat. This trial is registered, ISRCTN43722548.Findings We did baseline surveys of 15 261 young adults in 24 Peruvian cities. Of those, 20 geographically separate cities were matched into pairs, in each of which one city was assigned to intervention and the other to standard of care. In the 2006 follow-up survey, data for the composite primary outcome were available for 12 930 young adults. We report a non-significant reduction in prevalence of STIs in young adults, adjusted for baseline prevalence, in intervention cities compared with control cities (relative risk 0.84, 95% CI 0-69-1.02; p=0.096). In subgroup analyses, significant reductions were noted in intervention cities in young adult women and FSWs.Interpretation Syndromic management of STIs, mobile-team outreach to FSWs, presumptive treatment for trichomoniasis in FSWs, and condom promotion might reduce the composite prevalence of any of the four curable STIs investigated in this trial.