White R G, Moodley P, McGrath N, Hosegood V, Zaba B, Herbst K, Newell M, Sturm W A, Hayes R J
Infectious Disease Epidemiology Unit, Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
Sex Transm Infect. 2008 Dec;84(7):528-34. doi: 10.1136/sti.2008.032011. Epub 2008 Aug 15.
Syndromic sexually transmitted infection (STI) treatment remains a cost-saving HIV prevention intervention in many countries in Africa. We estimate the effectiveness of syndromic treatment for curable STIs in rural KwaZulu-Natal, South Africa, and the trend in STI prevalences before and after the introduction of syndromic treatment in 1995.
Data were available from various clinical studies, surveys of public and private health providers, the general population and women attending antenatal, family planning and child immunisation clinics in rural northern KwaZulu-Natal between 1987 and 2004. Overall effectiveness was defined as the estimated proportion of the annual number of symptomatic curable STI episodes cured by syndromic treatment based on separate estimates for six curable STI aetiologies by gender.
Median overall effectiveness was 13.1% (95% CI 8.9 to 17.8%) of symptomatic curable STI episodes cured. Effectiveness increased to 25.0% (95% CI 17.3 to 33.8%), 47.6% (95% CI 44.5 to 50.8%) or 14.3% (95% CI 9.9 to 19.4%) if 100% treatment seeking, 100% correct treatment provision or 100% cure were assumed, respectively. Time-trends were difficult to assess formally but there was little evidence of decreasing STI prevalences. Including incurable but treatable herpes simplex virus (HSV)-2 ulcers in the effectiveness calculation would halve the proportion of ulcers cured or correctly treated, but this reduction could be entirely countered by including episodic antiviral treatment in the national guidelines.
Overall effectiveness of syndromic treatment for curable STIs in rural KwaZulu-Natal remains low and there is little evidence of reduced curable STI prevalences. As syndromic treatment is likely to be a cost-saving HIV prevention intervention in South Africa, innovative strategies are urgently needed to increase rates of treatment seeking and correct treatment provision.
在非洲许多国家，性传播感染（STI）综合征治疗仍是一种节省成本的艾滋病预防干预措施。我们评估了南非夸祖鲁 - 纳塔尔农村地区针对可治愈性传播感染的综合征治疗效果，以及1995年引入综合征治疗前后性传播感染患病率的变化趋势。
数据来自1987年至2004年间在夸祖鲁 - 纳塔尔北部农村地区开展的各项临床研究、对公立和私立医疗服务提供者的调查、普通人群以及前往产前、计划生育和儿童免疫诊所就诊的妇女的调查。总体效果定义为基于按性别对六种可治愈性传播感染病因的单独估计，通过综合征治疗治愈的有症状可治愈性传播感染发作年度数量的估计比例。
有症状可治愈性传播感染发作的总体效果中位数为治愈13.1%（95%置信区间8.9%至17.8%）。如果假设100%寻求治疗、100%正确提供治疗或100%治愈，效果分别提高到25.0%（95%置信区间17.3%至33.8%）、47.6%（95%置信区间44.5%至50.8%）或14.3%（95%置信区间9.9%至19.4%）。时间趋势难以正式评估，但几乎没有证据表明性传播感染患病率在下降。在效果计算中纳入不可治愈但可治疗的单纯疱疹病毒2型（HSV - 2）溃疡，会使溃疡治愈或正确治疗的比例减半，但在国家指南中纳入间歇性抗病毒治疗可完全抵消这一降低。
夸祖鲁 - 纳塔尔农村地区针对可治愈性传播感染的综合征治疗总体效果仍然较低，几乎没有证据表明可治愈性传播感染患病率有所降低。由于综合征治疗在南非可能是一种节省成本的艾滋病预防干预措施，迫切需要创新策略来提高寻求治疗率和正确提供治疗的比例。
