Predictors of HIV/STI Incidence Among Female Sex Workers in Rwanda and Zambia 公开

Wesley, Meredith Grace (2017)

Permanent URL: https://etd.library.emory.edu/concern/etds/zk51vh740?locale=zh
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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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