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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
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
Background: 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 prevalence of chlamydia, gonorrhea, trichomoniasis, syphilis, HSV-2, and bacterial vaginosis (BV) among women in sub-Saharan Africa by age, region, and population-type.Methods and Findings: We analyzed individual-level data from 18 HIV prevention studies (cohort studies, randomized controlled trials; conducted during 1993–2011), representing >37,000 women, which tested participants for ≥1 selected STI/BV at baseline. We used a two-stage meta-analysis to combine data. After calculating the proportion with each STI/BV and standard error by study, we used a random-effects model to obtain a summary mean prevalence of each STI/BV and 95% confidence interval (CI) across age, region, and population-types. Despite substantial study heterogeneity for some STIs/populations, several patterns emerged. Across all regions/population groups, 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: 4.4, 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 all region/population groups, HSV-2 and BV prevalence was high among 25–49 year-olds (ranging from 70–83% and 33–44%, respectively). The main study limitation is that the data are not from random samples of the target populations. Conclusions: 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.
1549-1277
1-38
Torrone, Elizabeth
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Morrison, Charles
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Chen, Pai-Lien
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Kwok, Cynthia
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Francis, Suzanna
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Hayes, Richard
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Looker, Katharine
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McCormack, Sheena
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Mcgrath, Nuala
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van de Wijgert, Janneke
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Watson-Jones, Deborah
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Low, Nicola
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Gottlieb, Sami
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Torrone, Elizabeth
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Morrison, Charles
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Chen, Pai-Lien
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Kwok, Cynthia
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Francis, Suzanna
357a1045-a78d-4d11-aede-bf66a3b46c27
Hayes, Richard
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Looker, Katharine
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McCormack, Sheena
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Mcgrath, Nuala
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van de Wijgert, Janneke
f54154a8-9f48-4dba-aaca-2f5121fdcb0b
Watson-Jones, Deborah
83e5e58c-2eb1-4d28-af2d-5cee612fb636
Low, Nicola
2d1bcb64-88f6-4657-a493-8fa588cb7173
Gottlieb, Sami
127e7292-9b93-4278-8df1-3dca70f4539a

Torrone, Elizabeth, Morrison, Charles, Chen, Pai-Lien, Kwok, Cynthia, Francis, Suzanna, Hayes, Richard, Looker, Katharine, McCormack, Sheena, Mcgrath, Nuala, van de Wijgert, Janneke, Watson-Jones, Deborah, Low, Nicola and Gottlieb, Sami (2018) 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. PLoS Medicine, 15 (2), 1-38, [e1002511]. (doi:10.1371/journal.pmed.1002511).

Record type: Article

Abstract

Background: 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 prevalence of chlamydia, gonorrhea, trichomoniasis, syphilis, HSV-2, and bacterial vaginosis (BV) among women in sub-Saharan Africa by age, region, and population-type.Methods and Findings: We analyzed individual-level data from 18 HIV prevention studies (cohort studies, randomized controlled trials; conducted during 1993–2011), representing >37,000 women, which tested participants for ≥1 selected STI/BV at baseline. We used a two-stage meta-analysis to combine data. After calculating the proportion with each STI/BV and standard error by study, we used a random-effects model to obtain a summary mean prevalence of each STI/BV and 95% confidence interval (CI) across age, region, and population-types. Despite substantial study heterogeneity for some STIs/populations, several patterns emerged. Across all regions/population groups, 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: 4.4, 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 all region/population groups, HSV-2 and BV prevalence was high among 25–49 year-olds (ranging from 70–83% and 33–44%, respectively). The main study limitation is that the data are not from random samples of the target populations. Conclusions: 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.

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Accepted/In Press date: 19 January 2018
e-pub ahead of print date: 27 February 2018
Published date: 27 February 2018

Identifiers

Local EPrints ID: 417812
URI: http://eprints.soton.ac.uk/id/eprint/417812
ISSN: 1549-1277
PURE UUID: 11d6b2ee-4d43-44e9-8555-8e4680ab7afa
ORCID for Nuala Mcgrath: ORCID iD orcid.org/0000-0002-1039-0159

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Date deposited: 14 Feb 2018 17:30
Last modified: 13 Feb 2020 05:01

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