| A
community trial of the impact of improved sexually transmitted disease
treatment on the HIV epidemic in rural Tanzania: 2. Baseline survey
results.
Grosskurth H, Mosha F, Todd J, Senkoro K, Newell J, Klokke A, Changalucha
J, West B, Mayaud P, Gavyole A, et al.
African Medical and Research Foundation, Mwanza, Tanzania.
OBJECTIVES: To determine baseline HIV prevalence in a trial of
improved sexually transmitted disease (STD) treatment, and to investigate
risk factors for HIV. To assess comparability of intervention and
comparison communities with respect to HIV/STD prevalence and risk
factors. To assess adequacy of sample size. SETTING: Twelve communities
in Mwanza Region, Tanzania: one matched pair of roadside communities,
four pairs of rural communities, and one pair of island communities.
One community from each pair was randomly allocated to receive the
STD intervention following the baseline survey. METHODS: Approximately
1000 adults aged 15-54 years were randomly sampled from each community.
Subjects were interviewed, and HIV and syphilis serology performed.
Men with a positive leucocyte esterase dipstick test on urine, or
reporting a current STD, were tested for urethral infections. RESULTS:
A total of 12,534 adults were enrolled. Baseline HIV prevalences
were 7.7% (roadside), 3.8% (rural) and 1.8% (islands). Associations
were observed with marital status, injections, education, travel,
history of STD and syphilis serology. Prevalence was higher in circumcised
men, but not significantly after adjusting for confounders. Intervention
and comparison communities were similar in the prevalence of HIV
(3.8 versus 4.4%), active syphilis (8.7 versus 8.2%), and most recorded
risk factors. Within-pair variability in HIV prevalence was close
to the value assumed for sample size calculations. CONCLUSIONS:
The trial cohort was successfully established. Comparability of
intervention and comparison communities at baseline was confirmed
for most factors. Matching appears to have achieved a trial of adequate
sample size. The apparent lack of a protective effect of male circumcision
contrasts with other studies in Africa.
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