Predictors of HIV/STI Incidence Among Female Sex Workers in Rwanda and Zambia Open Access
Wesley, Meredith Grace (2017)
Abstract
Background
Female sex workers (FSW) are at a disproportionately high risk
of HIV acquisition (2) - a disparity affected by a multitude of
risk factors that extends into other areas of sexual and
reproductive health. The aim of this study was to determine the
rate and contributing factors for incident sexually transmitted
infection (STI) including HIV, syphilis and trichomonas in FSW in
Rwanda and Zambia.
Methods
From 2012-2015, RZHRG recruited FSW in Zambia and Rwanda. Participants received demographic and risk behavior questionnaires and a gynecologic examination (when indicated) at baseline and follow-up visits. Crude hazard ratios were calculated for all indicators and multivariate Cox proportional hazard models were specified using indicators significantly associated (p<0.05) with the outcome, stratified by country.
Results
Among 458 participants in Rwanda, 101 incident infections occurred at a rate of 16 cases per 100 person-years (95% CI: 12.85, 19.07) and in Zambia, 138 incident infections occurred among 555 participants at a rate of about 24 cases per 100 PY (95% CI: 18.99, 26.76). About 80% of covariates varied significantly between countries. The model for Rwanda includes younger age at first sex, treatment of vaginal discharge in the prior year and report of a chronic ulcer. For Zambia, the model includes younger age at first sex, widowed marital status, increased number of repeat and non-repeat clients in the prior month and report of vaginal itching.
Conclusions
Based on significant associations shown in this analysis, age of sexual debut, marital status, gynecologic symptoms and number of repeat and non-repeat clients are all important factors in determining the occurrence of incident infections in FSW. Recognizing that FSW are a heterogeneous population across regions will better inform prevention strategies and interventions.
Table of Contents
Chapter 1 - Background.......................................................1
Chapter II - Manuscript.......................................................8
Abstract...........................................................................8
Introduction......................................................................9
Methods..........................................................................11
Results............................................................................15
Discussion........................................................................17
References.......................................................................23
Tables
Table 1: Participant demographics -
Rwanda............................28
Table 2: Participant demographics -
Zambia.............................31
Table 3: Cross-country comparisons.......................................34
Table 4: Univariate models - Rwanda......................................37
Table 5: Univariate models - Zambia.......................................39
Table 6: Multivariate models..................................................42
Figures
Figure 1: Components of cumulative outcome by country...........43
Chapter III - Public Health Implications...................................44
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