BOX 2-1Results of Community Randomized Controlled Trials of Interventions for Sexually Transmitted Infections

In Mwanza, Tanzania, syndromic management of STIs led to significantly (42 percent over 2 years) lower HIV incidence in intervention compared with control communities (Grosskurth et al., 1995). In Rakai, Uganda, mass antibiotic administration to control STIs and thereby HIV led to significant reductions in syphilis (relative risk [RR] = 0.8; 95 percent confidence interval [CI] 0.71–0.89) and trichomonas (RR = 0.59; 95 percent CI 0.38–0.91) but no reductions in gonorrhoea, chlamydia, or HIV (Wawer et al., 1999). Reductions in STI prevalence were observed in Masaka, Uganda, where the prevalence of active syphilis (RR = 0.52; 95 percent CI 0.27–0.98) and gonorrhoea (RR = 0.25; 95 percent CI 0.10–0.64) was lower in the syndromic management and information, education, and communication (IEC) arm (but not in the IEC-alone arm) compared with the control arm. However, there was no concomitant reduction in chlamydia prevalence and HIV incidence (Kamali et al., 2003). A trial of syndromic STI management and a peer-led targeted behavior change and condom promotion intervention in Manicaland, rural Zimbabwe, showed no impact on HIV incidence and no difference in reported STI syndromes (Gregson et al., 2007). A community RCT of adolescent sexual health interventions in Tanzania showed no impact on biological outcomes (Ross et al., 2007).

STI control programs can decrease HIV incidence under certain programmatic settings and epidemic circumstances. Many negative trials following the promising original Mwanza study have suggested that the intervention in isolation is not robust in diminishing HIV incidence. Nevertheless, the role of STI control remains relevant for multicomponent interventions and should be studied further (Grosskurth et al., 2000; Tanton et al., 2010).

From: 2, The Future Impact of Current Decisions

Cover of Preparing for the Future of HIV/AIDS in Africa
Preparing for the Future of HIV/AIDS in Africa: A Shared Responsibility.
Institute of Medicine (US) Committee on Envisioning a Strategy for the Long-Term Burden of HIV/AIDS: African Needs and U.S. Interests.
Washington (DC): National Academies Press (US); 2011.
Copyright 2011 by the National Academy of Sciences. All rights reserved.

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