AEGiS-11IAC: Comprehensive community-based sample collection and testing for the assessment of HIV and STD/GTI prevalence in rural Uganda.

11th International AIDS Conference

Vancouver, British Columbia — July 7-12, 1996

Comprehensive community-based sample collection and testing for the assessment of HIV and STD/GTI prevalence in rural Uganda.

Int Conf AIDS 1996 Jul 7-12; 11:438 (abstract no. Pub.A.1005)
McNairn D, Paxton L, Wabwire-Mangen F, Wawer M, Quinn T, Sewankambo NK, Gaydos C; Makerere Univ. Kampala, Uganda.

OBJECTIVE: We assessed the utility of several tests not previously used extensively in a community-based setting to determine the prevalence of HIV and other STD/GTIs (Genital tract infection) in a rural population of Uganda.

METHODS: Between Nov 1994 and June 1995, we established a cohort consisting of all consenting adults aged 15-59 and resident in 58 rural communities of Rakai District, Uganda. All were asked to provide whole blood for HIV-1, HSV-2, chancroid and syphilis serology (TRUST test, New Horizons, MD, USA). Urines were collected for ligase chain reaction (LCR) for gonorrhea and Chlamydia trachomatis (Abbott Laboratories, Ill, USA). Women provided one self-administered vaginal swab for bacterial vaginosis (BV) Gram stain and another for trichomonas culture (InPouch TVTM, BIOMED, CA, USA). All samples were collected in the home; none required genital examination by project personnel. All sample processing, and syphilis, trichomonas and BV testing were conducted in our field laboratory. HIV testing was carried out at Uganda Virus Research Institute in Entebbe, Uganda. Urinary LCR and HSV-2 western blots were conducted at Johns Hopkins, MD, USA. Chancroid EIAs were carried out at CDC, USA.

RESULTS: Of the 12,823 persons enrolled, 90% provided a serological sample and 94% gave urine; 95% of women provided two vaginal swabs. Specimen collection did not require medical training or specialized field equipment. The InPouch culture and BV Gram slide test required little laboratory technician time and provided rapid data on vaginal infections. The Trust test allowed us to give syphilis results and treatment within 24 hours. Preliminary data indicate high baseline HIV-1 and other STD/GTI rates (HIV 17%, syphilis 12%, trichomoniasis 24%, bacterial vaginosis 54%, chancroid 18%, chlamydia in women aged 15-29 6%). Testing of urine for GC and serum for HSV-2 is in progress.

CONCLUSIONS: It is feasible to conduct comprehensive home-based STD/GTI prevalence surveys using accurate new technologies that detect more infections than previously possible in a community setting. This avoids the selection bias common in clinic-based studies. The technologies are of value in obtaining the unbiased prevalence rates essential to determine the public health importance of STD/GTIs and their interactions with HIV at the population level.

Keywords: AEGIS, Sexually Transmitted Diseases, Prevalence, HIV-1, Vaginosis, Bacterial, Gonorrhea, Chlamydia Infections, Chancroid, Trichomonas Vaginitis, Uganda, Syphilis, Trichomonas, Human, Female, Animal, Adult, epidemiology, ICA11

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PubA1005