STD services for women at truck stop in Tanzania: evaluation of acceptable approaches.

AIDS continues to be the commonest cause of death in Tanzania among those aged between 15 and 45 years. Both ulcerative and non-ulcerative sexually transmitted diseases have been identified as major co-factors in HIV transmission. Certain groups including long distance truck drivers and their sexual partners have been reported as having a disporportionate effect on the transmission dynamics of STD including HIV, in a population. In 1993 African Medical and Research Foundation decided to add an STD component to their HIV/AIDS prevention programme along the Tanzania-Zambia highway which had been targeting truck drivers and their sexual partners through peer education and condom distribution since 1989. A study to evaluate the acceptability and feasibility of four different approaches of delivering STD services, was conducted over a period of one year. The approaches for delivering STD services were: special STD services offered twice a week at a site and at hours of the women's choice, special outreach services once every three months, or STD services integrated into the nearest Primary Health Clinic. Drugs were provided at three of the four interventions. 1,330 women at seven truckstops, participated in the evaluation study. The women were generally satisfied with all approaches that included the provision of drugs. The most expensive and ineffective way of treating STD was by not providing drugs. These findings confirm the fact that it is feasible to provide STD services to women at high risk in HIV high transmission areas. These women would utilise STD services provided in a manner that suits them if mobilised and encouraged by their peer educators.

PIP: Long-distance truck drivers and their sexual partners have a disproportionate effect on the transmission dynamics of sexually transmitted diseases (STDs), including HIV infections, in Tanzania. In 1993, the African Medical and Research Foundation added an STD component (peer education and condom distribution) to its HIV/AIDS prevention program along the Tanzania-Zambia highway. The present study of 1330 women (mean age, 27.3 years) recruited from 7 highway truckstops assessed the acceptability and feasibility of 4 approaches to the prevention of STDs: special STD services offered twice a week at a site and hours chosen by women, special clinic-based outreach services for women once every 3 months, integration of STD services into the nearest primary health care clinic, and provision of STD drugs. Most study participants were local brew sellers (47.2%), bar/guest house attendants (27%), and petty traders (21.1%). The overall HIV prevalence was 50%. Attendance per woman was higher when services were offered outside a health facility (1.23) or at times other than normal clinic hours (1.43) than when STD services were integrated with primary health care (1.0). The total cost per patient was US$11 when the clinic did not provide STD drugs, $12 for special clinic-based services for women, $11.50 for non-clinic-based services, and $11 for the integrated STD/primary health care approach. Women were equally satisfied with the 3 service delivery strategies, but highly dissatisfied when STD-specific drugs were not provided and their infection was not cured.

Regional variation in prevalence of antibody against human T-lymphotropic virus types I and III in Kenya, East Africa.

The prevalence of antibodies against HTLV-III and -I was studied among populations of 6 distinctly different regions of Kenya, an equatorial African country in which AIDS has rarely been observed. Overall, 21% of subjects had ELISA reactions suggesting the presence of antibody against HTLV-III. The frequency of HTLV-III antibodies was highest among the Turkana people (50%) and lowest among the Masai (8%). Prevalence increased with age but was not related to sex. The pattern of ELISA-detected antibody against HTLV-I was similar. The specificity of these antibodies was supported by Western blot analysis of a subset of sera with high and low ELISA ratios, in which 66% and 73% of those with ELISA ratios considered positive (= greater than 5.0 in this study) also had a profile of bands consistent with HTLV-III and HTLV-I respectively. The antibodies detected were not cross-reactive between HTLV-III and HTLV-I on Western blot analysis. In a series of subjects with various parasitic and infectious diseases, patients with idiopathic splenomegaly and with schistosomiasis had a high proportion of antibodies against both HTLV-III and HTLV-I. This survey shows that reactivity in the ELISA HTLV-III and HTLV-I assays are common among Kenyans but vary considerably by region.

Viral haemorrhagic fever surveillance in Kenya, 1980-1981.

Following two cases of Marburg virus disease in Kenya in 1980, viral haemorrhagic fever surveillance was undertaken in western Kenya. Over a 21-month period investigations, including virus isolation attempts, patient and contact serology, visits to areas where suspected cases occurred, interviewing family members and neighbours of suspected cases and following up any additional illnesses in these areas, were carried out. During the study two cases were found that were likely to have been Ebola haemorrhagic fever based on rising antibody titres or positive serology in contacts. Diagnoses of hepatitis A, hepatitis B, malaria, bacterial septicaemia or other causes were arrived at in 24 cases. No diagnosis could be made in 26 instances. 741 human sera were tested for antibodies against Marburg, Ebola, Congo haemorrhagic fever, Rift Valley fever or Lassa fever viruses by indirect fluorescence. Eight sera were positive for Ebola virus antibodies, all of which were from suspected cases or contacts of suspected cases. Two sera were antibody positive to Congo virus and one had antibodies against Rift Valley fever virus. No Marburg or Lassa virus antibodies were detected.

Antibodies against haemorrhagic fever viruses in Kenya populations.

Human sera from Lodwar (77 sera), Nzoia (841 sera), Masinga (251 sera), Laisamis (174 sera) and the Malindi/Kilifi area (556 sera) in Kenya were tested by indirect immunofluorescence for antibodies against Marburg, Ebola (Zaire and Sudan strains), Congo haemorrhagic fever, Rift Valley fever and Lassa viruses. Antibodies against Ebola virus, particularly the Zaire strain, were detected in all regions and were, over-all, more abundant than antibodies against the other antigens. Ebola and Marburg antibody prevalence rates were highest in the samples from Lodwar and Laisamis, both semi-desert areas. Antibodies against Rift Valley fever virus were also highest in the Lodwar sample followed by Malindi/Kilifi and Laisamis. Congo haemorrhagic fever virus antibodies were rare and no antibodies against Lassa virus were detected in the 1899 sera tested.