Factors associated with incident bacterial vaginosis in an HIVsero-discordant couple cohort, Zambia, 1994-2012 Public

Abstract

Background: Previous studies have shown a strong association between various genital abnormalities such as bacterial vaginosis and increased risk of transmission of HIV. However, few studies have examined the predictors of bacterial vaginosis in the context of sero-discordant, heterosexual couples. This study seeks to address the gap in knowledge by determining predictors of bacterial vaginosis. Methods: Data were obtained from a longitudinal cohort study with open enrollment that lasted from 1994 to 2012. This study involved married or co-habituating heterosexual HIV sero-discordant couples who participated in couples’ voluntary HIV counseling and testing (CVCT) in Lusaka, Zambia. Multivariate analyses were run to determine predictors of bacterial vaginosis among this population. Results: In HIV-negative women, factors associated (p<0.05) with incident BV included having a partner with HIV stage I-III (versus IV) disease, male partners having foreskin smegma, and the woman testing positive for trichomonas; use of implant (versus non-hormonal methods), sperm presence on a vaginal swab wet prep, and breastfeeding were protective for BV. In HIV-positive women, factors associated (p<0.05) with incident BV included use of implant (versus non-hormonal methods), increasing number of unprotected sexual acts with the partner, and the woman testing positive for trichomonas; sperm presence on a vaginal swab wet prep and breastfeeding were protective for BV. Conclusion: Women infected with trichomonas appear to have increased susceptibility to BV, and male circumcision status and hygiene may also play a role in BV risk. The interesting finding that breastfeeding was protective for BV could indicate lack of sexual activity, and this finding warrants further exploration. The role of unprotected sex is unclear, and we did not have enough implant users to draw conclusions about that finding.

Table of Contents

CHAPTER I: BACKGROUND AND LITERATURE REVIEW 1

CHAPTER II: MANUSCRIPT 3

INTRODUCTION 3

METHODS 3

RESULTS 6

DISCUSSION 7

STRENGTHS 8

LIMITATIONS 8

REFERENCES 10

CHAPTER III: SUMMARY, PUBLIC HEALTH IMPLICATIONS, FUTURE STUDIES 18

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Global Epidemiology - MPH & MSPH
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Mot-clé	HIV epidemiology AIDS Zambia
Committee Chair / Thesis Advisor	Wall, Kristin, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs

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