Syndromic management of sexually-transmitted infections and behaviour change interventions on transmission of HIV-1 in rural Uganda: a community randomised trial
Syndromic management of sexually-transmitted infections and behaviour change interventions on transmission of HIV-1 in rural Uganda: a community randomised trial
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DOI：
10.1016/s0140-6736(03)12598-6
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发表时间：
2003-02-22
期刊：
影响因子：
168.9
通讯作者：
Whitworth, J
中科院分区：
文献类型：
--
作者：
Kamali, A;Quigley, M;Whitworth, J
背景性传播感染的治疗和行为干预是发展中国家预防艾滋病毒的主要方法。我们的目的是评估这些干预措施对HIV-1和其他性传播感染的影响。方法我们随机分配居住在乌干达农村18个社区的所有成年人接受单独的行为干预(A组)、行为和性传播感染干预(B组)或常规的政府卫生服务和社区发展活动(C组)。主要结果是HIV-1的发病率。次要结果是单纯疱疹病毒2型(HSV2)和活动性梅毒的发病率以及淋病、衣原体、报告的生殖器溃疡、报告的生殖器分泌物和行为改变的标志的流行。A组HIV-1感染率为0.94(0.60~1.45，p=0.72)，B组为1.00(0.63~1.58，p=0.98)；A组与最后一次性伴侣使用安全套的患病率分别为1.12(95%CI 0.99~1.25)和1.27(1.02~1.56)。A组HSV2发病率低于C组(发病率比0.65，P<0.05)。B组活动性梅毒发生率和淋病患病率均低于C组(活动性梅毒发生率分别为0.52、0.27~0.98；淋病流行比率，0.25，0.10-0.64)。解释说，我们使用的干预措施不足以降低乌干达农村地区的艾滋病毒-1发病率，那里正在发生长期变化。需要制定更有效的性传播感染和行为干预措施，以控制成熟流行病中的艾滋病毒。
Background Treatment of sexually-transmitted infections (STIs) and behavioural interventions are the main methods to prevent HIV in developing countries. We aimed to assess the effect of these interventions on incidence of HIV-1 and other sexually-transmitted infections.Methods We randomly allocated all adults living in 18 communities in rural Uganda to receive behavioural interventions alone (group A), behavioural and STI interventions (group B), or routine government health services and community development activities (group C). The primary outcome was HIV-1 incidence. Secondary outcomes were incidence of herpes simplex virus type 2 (HSV2) and active syphilis and prevalence of gonorrhoea, chlamydia, reported genital ulcers, reported genital discharge, and markers of behavioural change. Analysis was per protocol.Findings Compared with group C, the incidence rate ratio of HIV-1 was 0.94 (0.60-1.45, p=0.72) in group A and 1.00 (0.63-1.58, p=0.98) in group B, and the prevalence ratio of use of condoms with last casual partner was 1.12 (95% CI 0.99-1.25) in group A and 1.27 (1.02-1.56) in group B. Incidence of HSV2 was lower in group A than in group C (incidence rate ratio 0.65, 0.53-0.80) and incidence of active syphilis for high rapid plasma reagent test titre and prevalence of gonorrhoea were both lower in group B than in group C (active syphilis incidence rate ratio, 0.52, 0.27-0.98; gonorrhoea prevalence ratio, 0.25, 0.10-0.64).Interpretation The interventions we used were insufficient to reduce HIV-1 incidence in rural Uganda, where secular changes are occurring. More effective STI and behavioural interventions need to be developed for HIV control in mature epidemics.