Elsevier

The Lancet

Volume 346, Issue 8974, 26 August 1995, Pages 530-536
The Lancet

Articles
Impact of improved treatment of sexually transmitted diseases on HIV infection in rural Tanzania: randomised controlled trial

https://doi.org/10.1016/S0140-6736(95)91380-7Get rights and content

Abstract

Summary

A randomised trial was done to evaluate the impact of improved sexually transmitted disease (STD) case management at primary health care level on the incidence of HIV infection in the rural Mwanza region of Tanzania. HIV incidence was compared in six intervention communities and six pair-matched comparison communities. A random cohort of about 1000 adults aged 15-54 years from each community was surveyed at baseline and at follow-up 2 years later. Intervention consisted of establishment of an STD reference clinic, staff training, regular supply of drugs, regular supervisory visits to health facilities, and health education about STDs.

12 537 individuals were recruited. Baseline HIV prevalences were 3·8% and 4·4% in the intervention and comparison communities, respectively. At follow-up, 8845 (71%) of the cohort were seen. Of those initially seronegative, the proportions seroconverting over 2 years were 48 of 4149 (1·2%) in the intervention communities and 82 of 4400 (1·9%) in the comparison communities. HIV incidence was consistently lower in the intervention communities in all six matched pairs. Allowing for the community-randomised design and the effects of confounding factors, the estimated risk ratio was 0·58 (95% Cl 0·42-0·79, p=0·007). No change in reported sexual behaviour was observed in either group.

We conclude that improved STD treatment reduced HIV incidence by about 40% in this rural population. This is the first randomised trial to demonstrate an impact of a preventive intervention on HIV incidence in a general population.

References (26)

  • World Health Organization

    The current global situation of the HIV/AIDS pandemic

    Wkly Epidemiol Rec

    (1995)
  • World Health Organization

    Update on AIDS

    Wily Epidemiol Rec

    (1991)
  • A. Oakley et al.

    Behavioural interventions for HIV/AIDS prevention

    AIDS

    (1995)
  • A. DeSchryver et al.

    Epidemiology of sexually transmitted diseases: the global picture

    Bull World Health Organ

    (1990)
  • Dw Cameron et al.

    Female to male transmission of human immunodeficiency virus type 1: risk factors for seroconversion in men

    Lancet

    (1989)
  • Fa Plummer et al.

    Cofactors in male-female sexual transmission of human immunodeficiency virus type 1

    J Infect Dis

    (1991)
  • M. Laga et al.

    Non-ulcerative sexually transmitted diseases as risk factors for HIV-transmission in women: results from a cohort study

    AIDS

    (1993)
  • Jn Wasserheit

    Interrelationships between human immunodeficiency virus infection and other sexually transmitted diseases

    Sex Trans Dis

    (1992)
  • M. Over et al.

    HIV infection and sexually transmitted diseases

  • World Bank

    World development report 1993: investing in health

    (1993)
  • World Health Organization

    Management of patients with sexually transmitted diseases

    World Health Organ Tech Rep Ser

    (1991)
  • R. Hayes et al.

    A community trial of the impact of improved STD treatment on the HIV epidemic in rural Tanzania: 1. Design

    AIDS

    (1995)
  • Cited by (0)

    View full text