Determinants of the impact of sexually transmitted infection treatment on prevention of HIV infection: A synthesis of evidence from the Mwanza, Rakai, and Masaka intervention trials
Determinants of the impact of sexually transmitted infection treatment on prevention of HIV infection: A synthesis of evidence from the Mwanza, Rakai, and Masaka intervention trials
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DOI：
10.1086/425274
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发表时间：
2005-02-01
影响因子：
6.4
通讯作者：
Hayes, RJ
中科院分区：
文献类型：
--
作者：
Korenromp, EL;White, RG;Hayes, RJ
在坦桑尼亚的姆万扎和乌干达的Rakai和马萨卡进行的社区随机试验表明，人口特征是性传播感染（STI）治疗干预措施对人类免疫缺陷病毒（HIV）感染发生率影响的一个重要决定因素。我们对艾滋病毒和性传播感染传播进行了模拟建模，证实了Rakai和马萨卡试验影响较低的原因是乌干达低风险性行为导致可治愈性传播感染的发病率较低。艾滋病毒在乌干达的成熟流行，大多数艾滋病毒传播发生在性传播感染率高的核心群体之外，这也是艾滋病毒发病率低的原因。在姆万扎，对艾滋病毒的模拟影响要大得多，尽管观察到的影响大于从性传播感染减少中预测的影响，这表明随机误差也可能发挥了一定的作用。在提出的其他解释中，由于艾滋病毒相关的免疫抑制而导致的疱疹性溃疡的增加对乌干达流行期间抗生素治疗的影响的减少几乎没有贡献。STI治疗策略也不重要，因为综合征治疗和每年的大规模治疗在每个试验人群的模拟中显示出相似的有效性。总之，低风险行为和成熟的艾滋病毒流行解释了1990年代性病治疗对乌干达艾滋病毒发病率的有限影响。在高危性行为和性传播感染率高的人群中，性传播感染治疗干预措施可能大大有助于预防艾滋病毒感染。
Community-randomized trials in Mwanza, Tanzania, and Rakai and Masaka, Uganda, suggested that population characteristics were an important determinant of the impact of sexually transmitted infection (STI) treatment interventions on incidence of human immunodeficiency virus (HIV) infection. We performed simulation modeling of HIV and STI transmission, which confirmed that the low trial impact in Rakai and Masaka could be explained by low prevalences of curable STI resulting from lower-risk sexual behavior in Uganda. The mature HIV epidemics in Uganda, with most HIV transmission occurring outside core groups with high STI rates, also contributed to the low impact on HIV incidence. Simulated impact on HIV was much greater in Mwanza, although the observed impact was larger than predicted from STI reductions, suggesting that random error also may have played some role. Of proposed alternative explanations, increasing herpetic ulceration due to HIV-related immunosuppression contributed little to the diminishing impact of antibiotic treatment during the Ugandan epidemics. The strategy of STI treatment also was unimportant, since syndromic treatment and annual mass treatment showed similar effectiveness in simulations of each trial population. In conclusion, lower-risk behavior and the mature HIV epidemic explain the limited impact of STI treatment on HIV incidence in Uganda in the 1990s. In populations with high-risk sexual behavior and high STI rates, STIs treatment interventions may contribute substantially to prevention of HIV infection.