Sensitivity and specificity of herpes simplex virus-2 serological assays among HIV-infected and uninfected urban Ugandans.

Herpes simplex virus type 2 (HSV-2) is a risk factor for HIV-1 infection. We characterized HSV-2 serology assay performance in HIV-positive and HIV-negative Africans. Serostatus for HSV-2 and HIV-1 was determined in 493 serum specimens stored from a community HSV-2 prevalence survey in Kampala, Uganda. HSV-2 serology by Focus HerpeSelect ELISA, Biokit HSV-2 rapid assay and Kalon HSV-2 was compared with HSV-2 Western blot (WB) according to HIV-1 serostatus. Sensitivity/specificity was: 99.5%/70.2% for Focus, 97.0%/86.4% for Biokit and 97.5%/96.2% for Kalon. Focus with Biokit confirmation improved sensitivity/specificity (99.4%/96.8%, respectively). Use of a higher Focus index value cut-off of 2.2 instead of 1.1 increased specificity from 70.2% to 92.4%. Kalon had higher specificity than Focus (P < 0.001). Of commercially available HSV-2 serological assays, Kalon alone, or Focus ELISA followed by Biokit confirmation perform best. Improved HSV-2 assays are needed for HSV-2 and HIV-1 public health activities in Africa.

Human papillomavirus genotypes associated with cervical cytologic abnormalities and HIV infection in Ugandan women.

Human papillomavirus (HPV) infection is associated with almost all cases of cervical cancer, and cervical cancer is a common malignancy in women living in developing countries. A cross-sectional study was conducted to determine the prevalence of HPV infection, human immunodeficiency virus (HIV) infection, and cervical cytologic abnormalities in women presenting to a sexually transmitted infections clinic in Kampala, Uganda. In June and July, 2002, 135 women underwent complete physical exams including Papanicolaou (Pap) smears. HIV status was evaluated by serology. Cervical and vaginal swabs were obtained by clinicians and tested for HPV genotypes by PCR/reverse blot strip assay. Of the 106 women with cervical swabs adequate for HPV testing, the HPV prevalence was 46.2% (49/106). HIV prevalence was 34.9% (37/106). High risk genotypes 52, 58, and 16 were the genotypes detected most commonly. Eighteen percent (9/49) of women infected with HPV were found to have genotypes 16 and/or 18. Seventy-three percent (27/37) of HIV-positive women versus 16% (10/63) of HIV-negative women had abnormal Pap smears (P < 0.0001). Among HIV-positive women, abnormal Pap smears were associated with the presence of high risk HPV genotypes (P < 0.001). The majority of women infected with HPV attending this sexually transmitted infections clinic in Uganda were infected with high risk HPV genotypes other than 16 and 18. Future studies should focus on whether current HPV vaccine formulations, that are limited to high risk genotypes 16 and 18, would be effective at decreasing the burden of cervical cancer in this population.

Social marketing of pre-packaged treatment for men with urethral discharge (Clear Seven) in Uganda.

We implemented social marketing of pre-packaged treatment for men with urethral discharge (Clear Seven) in Uganda, and studied its feasibility, acceptability and effectiveness as a possible means to treat STDs and thereby prevent HIV. Clear Seven was distributed at private health care outlets in three rural districts and two divisions of the capital. Comparisons were made with a pre-intervention period in the same sites plus one additional rural district. There were almost universally positive attitudes to Clear Seven. Cure rate (84% versus 47%), treatment compliance (93% versus 87%), and condom use during treatment (36% versus 18%) were significantly higher among Clear Seven users (n=422) than controls (n=405). Partner referral was similar but fewer Clear Seven partners were symptomatic when seeking treatment. Distribution of socially marketed pre-packaged treatment for male urethritis should be expanded in sub-Saharan Africa. Consideration should be given to developing similar kits for women.

Efficacy of patient-delivered partner medication in the treatment of sexual partners in Uganda.

BACKGROUND: Patient-based partner referral (PBPR), which is the main method for treating sexual partners of patients with sexually transmitted diseases (STDs), has limited effectiveness. GOAL: The authors compared the efficacy of PBPR with patient-delivered partner medication (PDPM) among patients attending the Mulago STD clinic in Kampala, Uganda. STUDY DESIGN: A total of 383 patients (187 women, 196 men) with STDs were randomized to the PBPR or PDPM group. The proportion of sexual partners treated in either group was compared using the chi-square statistic by intention to treat for partners whose follow-up status was unknown. RESULTS: The two groups had similar background characteristics. Of the 237 partners elicited, 176 (74%) were reported treated in the PDPM group. In the PBPR group, in which 234 partners were elicited, 79 (34%) were referred to the treatment clinic. This difference was statistically significant (risk ratio [RR], 2.44; 95% CI, 1.95-3.07; P < 0.001). Furthermore, PDPM was more effective than PBPR for women and for casual partners for whom PBPR is considered difficult. For women, 86 of 103 partners in the PDPM group were reported treated, compared with 23 of 104 partners in the PBPR group (RR, 4.55; 95% CI, 2.92-7.08; P < 0.001). For casual partners, 18 of 51 (34%) were reported treated in the PDPM group, compared with only three of 45 partners (7%) who were referred in the PBPR group (RR, 1.43; 95% CI, 1.40-2.65; P < 0.01). CONCLUSION: Patient-delivered partner medication is more effective than patient-based partner referral in the treatment of sexual partners.

Determinants for having sex while symptomatic among patients with sexually transmitted infections in Uganda.

In order to identify predictors of having sex while symptomatic among patients with sexually transmitted infections (STIs), a cross-sectional study was done at Mulago STD clinic in Kampala, Uganda. Ninety eight patients with STIs who engaged in sex while symptomatic were compared with 40 patients who did not engage in sex while symptomatic on: social-demographic; STI symptoms, health seeking behavior; condom use, sexual behaviour; partner referral; and knowledge and attitudes about STIs. On univariate analysis the risk of having sex while symptomatic was increased by: being female (crude odds ratio (COR) 2.82,95% confidence interval (CI) 1.24-6.47), being married (COR 4.42, CI 1.89-10.43); presenting with other symptoms apart form vaginal / urethral discharge, genital ulcer, or low abdominal pain (COR 2.76, CI1.19-6.41); having a regular partner (COR3.14, 1.49-7.83); not having sex with a casual partner (COR 3.86 CI 1.46-10.29), and finding it difficult to refer sexual partners (COR 2.66, CI 1.04-6.86). The independent predictors of having sex while symptomatic were symptoms > 14 days duration (adjusted odds ratio (AOR) 8.01, CI 2.00-16.67), previous medications (AOR 5.85, CI 2.04-16.75) and finding it difficult to refer sexual partners (AOR 4.76, CI 1.45-16.67). To reduce the proportion of STI patients who engage in sex while symptomatic, there is need to strengthen health education messages that stress the importance of abstaining from sex while symptomatic and to provide effective treatment at the first level of contact with these patients.

Determinants for Having Sex while Symptomatic among Patients with Sexually Transmitted Infections in Uganda

In order to identify predictors of having sex while symptomatic among patients with sexually transmitted infections (STIs); a cross-sectional study was done at Mulago STD clinic in Kampala; Uganda. Ninety eight patients with STIs who engaged in sex while symptomatic were compared with 40 patients who did not engage in sex while symptomatic on: social-demographic; STI symptoms; health seeking behavior; condom use; sexual behaviour; partner referral; and knowledge and attitudes about STIs. On univariate analysis the risk of having sex while symptomatic was increased by: being female (crude odds ratio (COR) 2.82;95confidence interval (CI) 1.24-6.47); being married (COR 4.42; CI 1.89-10.43); presenting with other symptoms apart form vaginal / urethral discharge; genital ulcer; or low abdominal pain (COR 2.76; CI1.19-6.41); having a regular partner (COR3.14; 1.49-7.83); not having sex with a casual partner (COR 3.86 CI 1.46-10.29); and finding it difficult to refer sexual partners (COR 2.66; CI 1.04-6.86). The independent predictors of having sex while symptomatic were symptoms 14 days duration (adjusted odds ratio (AOR) 8.01; CI 2.00-16.67); previous medications (AOR 5.85; CI 2.04-16.75) and finding it difficult to refer sexual partners (AOR 4.76; CI 1.45-16.67). To reduce the proportion of STI patients who engage in sex while symptomatic; there is need to strengthen health education messages that stress the importance of abstaining from sex while symptomatic and to provide effective treatment at the first level of contact with these patients

Factors influencing sexual partner referral for sexually transmitted diseases in Uganda.

BACKGROUND AND OBJECTIVE: Patient-based partner referral has limited effectiveness. We studied factors associated with sexual partner referral among patients with sexually transmitted diseases (STDs) with a view of suggesting remedial action. GOAL: To examine the role of psychosocial variables vis-a-vis other variables in predicting sexual partner referral. STUDY DESIGN: A cross-sectional interview survey with 507 patients with STDs at an STD clinic in Kampala, Uganda. Multivariate analyses were used to identify independent predictors of sexual partner referral. RESULTS: Forty-two percent of the 599 partners elicited were referred. The independent factors that favored sexual partner referral were examined in the laboratory (adjusted odds ratio [AOR] 2.20, 95% confidence interval [CI] 1.20-4.05): psychosocial variables of intention (likelihood of referring the partner) (AOR 4.60, CI 1.58-13.36), self-efficacy (partner referral being easy) (AOR 3.22, CI 1.36-7.66), having a positive attitude toward partner referral (AOR 1.19, CI 1.06-1.33), and previous success in having referred a partner (AOR 9.78, CI 2.90-33.04). Other variables, such as age, sex, marital status, employment, and type of partner, that were significant on univariate analysis were not significant after multivariate analysis. CONCLUSION: By providing interventions to change the psychosocial variables, there is a high chance of improving compliance with sexual partner referral.

PIP: This study examined the role of psychosocial variables versus other variables in predicting sexual partner referral. Multivariate analyses were employed to identify independent predictors of sexual partner referral among 507 patients with sexually transmitted diseases in Kampala, Uganda. The study, which was carried out from May 1 to August 31, 1998, indicated that 42% of the 599 partners elicited were referred. The independent factors that favored sexual partner referral were examined in the laboratory and were 1) psychosocial variables of intention (likelihood of referring the partner); 2) self-efficacy (partner referral being easy), having a positive attitude toward partner referral; and 3) previous success in having referred a partner. Other variables, such as age, sex, marital status, employment, and type of partner, were no longer significant after the multivariate analysis was conducted. This study demonstrated that patient referral was mainly influenced by psychosocial variables compared to sociodemographic, disease-based, or type of partner variables. Thus, improvement of compliance with sexual partner referral should focus on interventions that change these psychosocial variables.

Efficacy of patient-delivered partner medication in the treatment of sexual partners in Uganda

Background: patient-based partner referral (PBPR); which is the main method for treating sexual partners of patients with sexually transmitted diseases (STDs); has limited effictiveness. Goal: The authors compared the efficacy of PBPR with patient-delivered partner medication (PDPM) among patients attending the Mulago STD clinic in Kampala; Uganda. Study design: A total of 383 patients (187 women; 196 men) with STDs were randomised to the PBPR or PDPM group. The proportion of sexual partners treated in either group was compared using the chosquare statistic by intention to treat for partners whose follow-up status was unknown. Results: The two groups has similar background characteristics. Of the 237 partners elicited; 176(74) were reported treated in the PDPM group. In the PBPR group; in which 234 partners were elicited; 79(34) were referred to the treatment clinic.This difference was statistically significant (risk ratio (RR); 2.44; 95CI; 1.95-3.07; P0.001). Furthermore; PDPM was more effective than PBPR for women and for casual partners for whom PBPR is considered difficult. For women; 86 of 103 partners in the PDPM group ; compared with only three of 45 partners (7) who were referred in the PBPR group (RR; 1.43; 95 CI; 1.40-2.65; p0.01). Conclusion : Patient-delivered partner medication is more effective than patient-based partner referral in the treatment of sexual partners