AEGiS-14IAC: STD declines in a South African mining community following addition of periodic presumptive treatment to a community HIV prevention project.

14th International AIDS Conference

Barcelona, Spain - July 7-12, 2002

STD declines in a South African mining community following addition of periodic presumptive treatment to a community HIV prevention project.

Int Conf AIDS 2002 Jul 7-12; 14:(abstract no. TuOrD1150)

Steen R, Olivier E, Mzaidume Z, Rasego B, Moema S, Fehler G, Leong MG, Williams BG, Ndhlovu L, van Dam CJ, Dallabetta G, Ballard RC, Neilsen G
Family Health International, Arlington, Virginia, United States

BACKGROUND: STD services for sex workers were implemented to reduce the prevalence of curable STDs in a mining area as part of a community HIV/STD prevention project .

METHODS: Two mobile clinics were deployed to areas near mine hostels frequented by sex workers and their clients. Peer educators encouraged all women at high risk to attend monthly for examination, STD treatment and counseling. Periodic presumptive treatment (PPT) with a single observed dose of azithromycin 1G was given monthly, then tapered to quarterly after the woman's sixth visit. Prevalence rates of N. gonorrhoeae and C. trachomatis in women attending the services were measured by urine ligase chain reaction (LCR). STD surveillance reports from mine and public clinics and local general practitioners (GP) for the quarter before PPT implementation were compared with the comparable quarter one year later.

RESULTS: In a cohort of women (n=180) attending the clinic at least nine times, the prevalence of N. gonorrhoeae was 15.1% at initial visit, 13.3% at the sixth visit and 8.9% at ninth visit (p=0.18). The prevalence of C. trachomatis was 16.8%, 2.8% and 3.9% at first, sixth and ninth visits (p<0.001) and of either infection, 25.8%, 15.0% and 11.1% respectively (p<0.001). Women reported no change in numbers of partners, but condom use with last client increased from 63% to 71% . A 46.7% decrease in male STDs was documented from passive surveillance.

CONCLUSIONS: This represents a successful replication in a new area of a targeted intervention resulting in rapid and large decreases in the prevalence of curable STDs. Reported condom use increased and tapering of PPT from monthly to quarterly did not result in rebound STD increases. Curative and preventive services including periodic presumptive treatment for women at high risk can rapidly reduce prevalence of curable STDs in important core populations, and contribute to reduction of STD prevalence in the wider community.

Keywords: AEGIS, Prostitution, HIV Infections, Prevalence, Mining, Gonorrhea, HIV Seropositivity, Azithromycin, Human, Female, Male, therapy, prevention & control

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