Prevalence of sexually transmitted infections and bacterial vaginosis among women in sub-Saharan Africa: An individual participant data meta-analysis of 18 HIV prevention studies.
Prevalence of sexually transmitted infections and bacterial vaginosis among women in sub-Saharan Africa: An individual participant data meta-analysis of 18 HIV prevention studies.
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DOI：
10.1371/journal.pmed.1002511
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发表时间：
2018-03
期刊：
影响因子：
15.8
通讯作者：
STIMA Working Group
中科院分区：
文献类型：
--
作者：
Torrone EA;Morrison CS;Chen PL;Kwok C;Francis SC;Hayes RJ;Looker KJ;McCormack S;McGrath N;van de Wijgert JHHM;Watson-Jones D;Low N;Gottlieb SL;STIMA Working Group
性传播感染流行率的估计对于预防和控制性传播感染的努力至关重要。目前很少有大型性传播感染流行率研究，特别是针对低收入和中等收入国家的研究。我们的主要目的是估计衣原体、淋病、滴虫病、梅毒、单纯疱疹病毒2型（HSV-2）和细菌性阴道病（BV）在撒哈拉以南非洲妇女中的年龄、地区和人口类型的患病率。我们分析了来自18项HIV预防研究（队列研究和随机对照试验，1993-2011年进行）的个体水平数据，这些研究代表了37,000名女性，这些女性在基线时检测了≥1种选定的性传播感染或BV。我们采用两阶段荟萃分析来合并数据。在计算了每种感染的参与者比例和研究的标准误差后，我们使用随机效应模型来获得不同年龄、地区和人群类型的每种感染的总平均患病率和95%置信区间（CI）。尽管对一些性传播感染/人群的研究存在很大的异质性，但仍出现了一些模式。在三个主要区域/人群中（南非社区、南部/东部非洲社区和高风险的东非），15 - 24岁妇女的所有性传播感染患病率高于25 - 49岁妇女，但单纯疱疹病毒-2除外。总体而言，高危人群的淋病和梅毒患病率高于诊所/社区人群。衣原体方面，在东非艾滋病毒高风险环境中专门招募的15 - 24岁妇女中，衣原体患病率为10.3% (95% CI: 7.4%, 14.1%; I2 = 75.7%)，在南非诊所/社区人群中，衣原体患病率为15.1% （95% CI: 12.7%, 17.8%; I2 = 82.3%）。在诊所/社区人群中，大多数性传播感染在南非的流行率普遍高于南部/东部非洲；淋病在南非15 - 24岁人群中的患病率为4.6% (95% CI: 3.3%, 6.4%; I2 = 82.8%)，在南部/东部非洲为1.7% （95% CI: 1.2%, 2.6%; I2 = 55.2%）。在三个主要区域/人群中，25 - 49岁人群中2型单纯疱疹病毒和细菌性疱疹病毒的患病率较高（分别为70%至83%和33%至44%）。研究的主要局限性在于数据并非来自目标人群的随机样本。结合18项艾滋病预防研究的数据，我们的发现突出了撒哈拉以南非洲妇女中性传播感染/细菌性传播感染流行病学的重要特征。该方法可用于常规性传播感染监测有限的地方，并为获取中低收入国家性传播感染和细菌性传播感染流行情况的关键信息提供了一种新方法。在一项观察性研究和随机试验的荟萃分析中，Elizabeth a . Torrone及其同事提供了撒哈拉以南非洲妇女人群中性传播感染和细菌性传播感染患病率的估计值。性传播感染（STIs）和细菌性阴道病（BV）可导致一系列性健康、生殖健康和母婴健康后果。在低收入和中等收入国家，很少有基于人群的性传播感染/细菌性传播感染流行率研究。许多艾滋病毒预防研究收集了性传播感染的基线数据，尽管这不是研究的主要目的，但这些数据可能有助于估计性传播感染/细菌性传播感染的流行情况。我们使用了在撒哈拉以南非洲进行的18项艾滋病毒预防研究的个人层面数据，这些研究在基线时对37,000多名艾滋病毒阴性妇女进行了一种或多种性传播感染或BV检测。通过一项两阶段的荟萃分析，我们按年龄、地区和人群类型估计了5种性传播感染（衣原体、淋病、滴虫病、梅毒和单纯疱疹病毒2型[HSV-2]）和BV在研究中的患病率。除2型单纯疱疹病毒外，所有性传播感染的感染率在15-24岁的年轻女性中最高，不论地区或人群类型。估计的性传播感染/细菌性传播感染流行率往往因地区而异。例如，从诊所/社区环境登记的南非妇女的衣原体和淋病患病率高于南部/东部非洲其他地方的类似人群。一些性传播感染，如梅毒，似乎主要集中在高危人群中。这项研究的发现加强了我们对撒哈拉以南非洲妇女中性传播感染/细菌性传播感染流行病学的理解。通过确定年龄、区域和人口类型在性传播感染/细菌性传播感染流行率方面的差异，该分析解决了世界卫生组织《2016-2021年全球卫生部门性传播感染战略》的第一支柱：增加信息，以便采取重点公共卫生行动。来自研究的现有数据为获取性传播感染/细菌性传播感染流行情况的关键信息提供了机会，并可用于常规性传播感染监测和独立性传播感染研究有限的地方。
Estimates of sexually transmitted infection (STI) prevalence are essential for efforts to prevent and control STIs. Few large STI prevalence studies exist, especially for low- and middle-income countries (LMICs). Our primary objective was to estimate the prevalence of chlamydia, gonorrhea, trichomoniasis, syphilis, herpes simplex virus type 2 (HSV-2), and bacterial vaginosis (BV) among women in sub-Saharan Africa by age, region, and population type. We analyzed individual-level data from 18 HIV prevention studies (cohort studies and randomized controlled trials; conducted during 1993–2011), representing >37,000 women, that tested participants for ≥1 selected STIs or BV at baseline. We used a 2-stage meta-analysis to combine data. After calculating the proportion of participants with each infection and standard error by study, we used a random-effects model to obtain a summary mean prevalence of each infection and 95% confidence interval (CI) across ages, regions, and population types. Despite substantial study heterogeneity for some STIs/populations, several patterns emerged. Across the three primary region/population groups (South Africa community-based, Southern/Eastern Africa community-based, and Eastern Africa higher-risk), prevalence was higher among 15–24-year-old than 25–49-year-old women for all STIs except HSV-2. In general, higher-risk populations had greater prevalence of gonorrhea and syphilis than clinic/community-based populations. For chlamydia, prevalence among 15–24-year-olds was 10.3% (95% CI: 7.4%, 14.1%; I2 = 75.7%) among women specifically recruited from higher-risk settings for HIV in Eastern Africa and was 15.1% (95% CI: 12.7%, 17.8%; I2 = 82.3%) in South African clinic/community-based populations. Among clinic/community-based populations, prevalence was generally greater in South Africa than in Southern/Eastern Africa for most STIs; for gonorrhea, prevalence among 15–24-year-olds was 4.6% (95% CI: 3.3%, 6.4%; I2 = 82.8%) in South Africa and was 1.7% (95% CI: 1.2%, 2.6%; I2 = 55.2%) in Southern/Eastern Africa. Across the three primary region/population groups, HSV-2 and BV prevalence was high among 25–49-year-olds (ranging from 70% to 83% and 33% to 44%, respectively). The main study limitation is that the data are not from random samples of the target populations. Combining data from 18 HIV prevention studies, our findings highlight important features of STI/BV epidemiology among sub-Saharan African women. This methodology can be used where routine STI surveillance is limited and offers a new approach to obtaining critical information on STI and BV prevalence in LMICs. In a meta-analysis of observational studies and randomized trials, Elizabeth A. Torrone and colleagues provide estimates of STI and BV prevalence among populations of sub-Saharan African women. Sexually transmitted infections (STIs) and bacterial vaginosis (BV) can result in a range of sexual, reproductive, and maternal-child health consequences. Few population-based studies of STI/BV prevalence exist for low- and middle-income countries. Many HIV prevention studies gather baseline data on STIs, and, although not the primary objective of the studies, these data may be useful for estimating STI/BV prevalence. We used individual-level data from 18 HIV prevention studies conducted in sub-Saharan Africa, which tested over 37,000 HIV-negative women for 1 or more STIs or BV at baseline. Using a 2-stage meta-analysis, we estimated the prevalence of 5 STIs (chlamydia, gonorrhea, trichomoniasis, syphilis, and herpes simplex virus type 2 [HSV-2]) and BV across studies by age, region, and population type. STI prevalence was highest among young women aged 15–24 years for all STIs except HSV-2, regardless of region or population type. Estimated STI/BV prevalence often varied by region. For example, chlamydia and gonorrhea prevalence was higher among South African women enrolled from clinic/community settings than among similar populations elsewhere in Southern/Eastern Africa. Some STIs, such as syphilis, appeared to be primarily concentrated among higher-risk populations. Findings from this study strengthen our understanding of STI/BV epidemiology among sub-Saharan African women. By identifying differences in STI/BV prevalence by age, region, and population type, this analysis addresses the first pillar of the World Health Organization Global Health Sector Strategy on Sexually Transmitted Infections 2016–2021: to increase information for focused public health action. Existing data from research studies provide an opportunity to obtain critical information on STI/BV prevalence and can be used where routine STI surveillance and stand-alone STI studies are limited.
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影响因子：
3.7
作者：
Kapiga SH;Ewings FM;Ao T;Chilongani J;Mongi A;Baisley K;Francis S;Andreasen A;Hashim R;Watson-Jones D;Changalucha J;Hayes R
通讯作者：
Hayes R
DOI：
10.1097/01.aids.0000390704.35642.47
发表时间：
2010-10
期刊：
AIDS (London, England)
影响因子：
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作者：
Hayes R;Watson-Jones D;Celum C;van de Wijgert J;Wasserheit J
通讯作者：
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影响因子：
5.5
作者：
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通讯作者：
Rees, Helen
DOI：
10.1093/humrep/deu113
发表时间：
2014-08
期刊：
Human reproduction (Oxford, England)
影响因子：
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作者：
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通讯作者：
McCormack S
影响因子：
56.3
作者：
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通讯作者：
Baeten, Jared M.