Impact of recurrent sexually transmitted infections on HIV seroconversion: Results from multi-state frailty models

Abstract

After several decades of research, South Africa is still considered to be the epicentre of HIV epidemic. The country also has the highest burden of sexually transmitted infections (STIs) which have been frequently linked to increasing rates of HIV transmission due to biological and behavioural associations between these two pathogeneses. We investigated the cumulative impact of recurrent STIs on subsequent HIV seroconversion among a cohort of South African women. We used the ‘ frailty’ models which can account for the heterogeneity due to the recurrent STIs in a longitudinal setting. The lowest HIV incidence rate was 5.0/100 person-year among women who had no baseline STI and remained negative during the follow-up. This estimate was three times higher among those who had recurrent STIs in the follow-up period regardless of their STI status at baseline (15.8 and 14.0/100 person-year for women with and without STI diagnosis at baseline, respectively). Besides younger age and certain partnership characteristics, our data provided compelling evidence for the impact of recurrent STI. diagnoses on increasing rates of HIV. At the population-level, 65% of HIV infections collectively associated with recurrent STIs. These results have significant clinical and epidemiological implications and may play critical role in the trajectory of the infections in the region.

Prevalence, incidence and recurrence of sexually transmitted infections in HIV‐negative adult women in a rural South African setting

“…Although comparative STI data of urban versus rural South African settings remains scarce [31,32], two South African studies found no or reverse associations between STI incidence and rural settings. In our study, it was shown that syndromic management is insufficient for the treatment and control of STIs, as is also described in literature [24,[33][34][35][36][37][38]. It has to be addressed that our data on the diagnostic accuracy of vaginal discharge originates from 2014 to 2016.…”

“…In our study, it was shown that syndromic management is insufficient for the treatment and control of STIs, as is also described in literature [24, 33–38]. It has to be addressed that our data on the diagnostic accuracy of vaginal discharge originates from 2014 to 2016.…”