Improved treatment services significantly reduce the prevalence of sexually transmitted diseases in rural Tanzania: Results of a randomized controlled trial
Improved treatment services significantly reduce the prevalence of sexually transmitted diseases in rural Tanzania: Results of a randomized controlled trial
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DOI：
10.1097/00002030-199715000-00013
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发表时间：
1997-12-01
期刊：
影响因子：
3.8
通讯作者：
Mabey, D
中科院分区：
文献类型：
--
作者：
Mayaud, P;Mosha, F;Mabey, D
目的：评价基层卫生保健改进性病病例管理对性病发病率和患病率的影响。设计：社区随机对照试验。环境：坦桑尼亚姆万扎地区。研究对象：随机抽取约1000名年龄在15-54岁之间的成年人，分别来自12个社区，分成6对。每对中的一名成员被随机分配接受干预，其他成员作为比较群体。该队列在基线和随访2年后进行调查。每个社区约有100名产前门诊服务人员也在两次情况下进行了研究：第一次是在实施干预措施后不久，第二次是在大约一年后。干预措施：在农村保健单位，采用综合病征方法，改善了性传播疾病管理服务。结果：共有12534人入选队列研究，其中8844人（71%）在2年后再次出现。血清学梅毒（快速血浆反应素滴度大于或等于1:8，梅毒螺旋体血凝素检测阳性）的患病率在基线时在干预和比较社区均为6.2%。随访时，干预组为5.0%，对照组为7.0%[校正相对危险度（RR）， 0.71；95%置信区间（CI）， 0.54-0.93；P < 0.02]。随访时，干预组与对照组男性尿道炎患病率无显著差异，但症状性尿道炎患病率降低了约50%（校正后RR为0.51；95% CI为0.24-1.10;P = 0.08）。在最后一年的随访期间，两组之间自我报告的性传播疾病症状的发生率没有显著差异，在产前诊所的任何性传播疾病的患病率方面也没有显著差异。结论：这项干预研究中先前报道的HIV发病率的降低可归因于持续时间的减少，从而减少了有症状性传播疾病的患病率。
Objective: To evaluate the impact of improved case management for sexually transmitted diseases (STD) at the primary health care level on the incidence and prevalence of STD.Design: Community-randomized controlled trial.Setting: Mwanza region, Tanzania.Subjects: A random cohort of about 1000 adults aged 15-54 years from each of 12 communities, in six matched pairs. One member of each pair was assigned at random to receive the intervention, and the others served as a comparison community. This cohort was surveyed at baseline and at follow-up 2 years later. About 100 antenatal clinic attenders were also studied in each community on two occasions: the first shortly after the implementation of the intervention, and the second approximately 1 year later.Intervention: Improved services were established for the management of STD, using the syndromic approach, in rural health units.Results: A total of 12 534 individuals were enrolled in the cohort study, of whom 8844 (71%) were seen again 2 years later. The prevalence of serological syphilis (rapid plasma reagin titre greater than or equal to 1:8, Treponema pallidum haemagglutinin assay positive) was 6.2% in both intervention and comparison communities at baseline. At follow-up it was 5.0% in the intervention community and 7.0% in the comparison community [adjusted relative risk (RR), 0.71; 95% confidence interval (CI), 0.54-0.93; P < 0.02]. The prevalence of urethritis in males did not differ significantly between intervention and comparison groups at follow-up, but the prevalence of symptomatic urethritis was reduced by about 50% (adjusted RR, 0.51; 95% CI, 0.24-1.10; P = 0.08). There was no significant difference between the groups in the incidence of self-reported STD symptoms over the last year of the follow-up period, or in the prevalence of any STD in antenatal clinic attenders.Conclusion: The reduction in HIV incidence previously reported in this intervention study can be attributed to a reduction in the duration, and hence the prevalence of symptomatic STD.