Rwanda Zambia Health Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, Georgia, USA.
J Infect Dis. 2021 Jul 2;224(1):81-91. doi: 10.1093/infdis/jiab071.
We explored the role of genital abnormalities and hormonal contraception in human immunodeficiency virus (HIV) transmission among heterosexual serodifferent couples in Rwanda.
From 2002 to 2011, HIV-serodifferent couples who were not using antiretroviral treatment were followed up, and sociodemographic and clinical data were collected, family planning provided, and HIV-negative partners retested. Couples were assessed for genital ulcers; nonulcerative genital sexually transmitted infection (STIs), including gonorrhea, chlamydia, and trichomoniasis; and non-STI vaginal infections, including bacterial vaginosis and candida. Multivariable models evaluated associations between covariates and HIV transmission genetically linked to the index partner.
Among 877 couples in which the man was HIV positive, 37 linked transmissions occurred. Factors associated with women's HIV acquisition included genital ulceration in the female partner (adjusted hazard ratio, 14.1) and nonulcerative STI in the male partner (8.6). Among 955 couples in which the woman was HIV positive, 46 linked transmissions occurred. Factors associated with HIV acquisition in men included nonulcerative STI in the female partner (adjusted hazard ratio, 4.4), non-STI vaginal dysbiosis (7.1), and genital ulceration in the male partner (2.6). Hormonal contraception use was not associated with HIV transmission or acquisition.
Our findings underscore the need for integrating HIV services with care for genital abnormalities. Barriers (eg, cost of training, demand creation, advocacy, and client education; provider time; and clinic space) to joint HIV/STI testing need to be considered and addressed.
我们探讨了性传播感染（STI）和激素避孕在卢旺达异性恋血清学不同的夫妇中传播人类免疫缺陷病毒（HIV）中的作用。
2002 年至 2011 年，随访未接受抗逆转录病毒治疗的 HIV 血清学不同的夫妇，收集社会人口学和临床数据，提供计划生育，并对 HIV 阴性的伴侣进行重新检测。评估夫妇是否存在生殖器溃疡；非溃疡性生殖器性传播感染（包括淋病、衣原体和滴虫病）；非 STI 阴道感染（包括细菌性阴道病和念珠菌病）。多变量模型评估了与 HIV 传播相关的协变量与与索引伴侣基因相关联的 HIV 传播之间的关联。
在 877 对男性 HIV 阳性的夫妇中，有 37 例发生了相关传播。与女性 HIV 感染相关的因素包括女性伴侣的生殖器溃疡（调整后的危险比，14.1）和男性伴侣的非溃疡性 STI（8.6）。在 955 对女性 HIV 阳性的夫妇中，有 46 例发生了相关传播。与男性 HIV 感染相关的因素包括女性伴侣的非溃疡性 STI（调整后的危险比，4.4）、非 STI 阴道菌群失调（7.1）和男性伴侣的生殖器溃疡（2.6）。激素避孕的使用与 HIV 传播或感染无关。
我们的研究结果强调了将 HIV 服务与生殖器异常护理相结合的必要性。需要考虑并解决联合 HIV/性传播感染检测的障碍（例如，培训成本、需求创造、宣传和客户教育；提供者时间；和诊所空间）。
