Periodical Antibiotic Treatment for the Control of Gonococcal and Chlamydial Infections Among Sex Workers in Benin and Ghana: A Cluster-Randomized Placebo-Controlled Trial

被引:11
|
作者
Labbe, Annie-Claude [1 ]
Pepin, Jacques [2 ]
Khonde, Nzambi [3 ]
Dzokoto, Agnes [4 ]
Meda, Honore [5 ]
Asamoah-Adu, Comfort [3 ]
Mayaud, Philippe [6 ]
Mabey, David [6 ]
Demers, Eric [7 ]
Alary, Michel [7 ,8 ]
机构
[1] Hop Maison Neuve Rosemont, Dept Microbiol, Montreal, PQ H1T 2M4, Canada
[2] Univ Sherbrooke, Dept Microbiol & Infect Dis, Sherbrooke, PQ J1K 2R1, Canada
[3] W Africa Project Combat AIDS, Accra, Ghana
[4] Minist Hlth, Accra, Greater Accra R, Ghana
[5] Projet SIDA3 Benin, Cotonou, Benin
[6] London Sch Hyg & Trop Med, Fac Infect & Trop Dis, Dept Clin Res, London WC1, England
[7] CHA Univ Quebec, Ctr Rech FRSQ, Unite Rech Sante Populat, Quebec City, PQ, Canada
[8] Univ Laval, Dept Med Sociale & Prevent, Quebec City, PQ, Canada
关键词
SEXUALLY-TRANSMITTED DISEASES; HIV-1; INFECTION; URETHRAL DISCHARGE; PREVALENCE; EPIDEMIOLOGY; PROSTITUTES; MEN; DIAGNOSIS; DYNAMICS; NAIROBI;
D O I
10.1097/OLQ.0b013e318244aaa0
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
Background: In resource-poor settings, control of Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) among female sex workers (FSWs) is difficult. We sought to determine whether periodical antibiotic treatment (PAT) might be effective in controlling these infections among West African FSWs. Secondary objectives were to determine the impact of PAT on human immunodeficiency virus (HIV) incidence among FSWs and on NG/CT prevalence among their clients. Methods: Cluster-randomized, double-blind, placebo-controlled trial among FSW communities in Benin and Ghana. Within each of 9 pairs of clusters of FSW communities, one was allocated to receive, during 9 months, a monthly antibiotic (alternatively ciprofloxacin or azithromycin, n = 296 FSWs) and the other a placebo (n = 340 FSWs). Prevalence of NG/CT infections was measured at 3-month intervals using the polymerase chain reaction. HIV status was determined at the beginning and at the end of the study. Results: After adjusting for age, HIV status, duration of prostitution, price per intercourse and condom use, and accounting for prevalence at enrollment and cluster-pairing effect, prevalence ratios (intervention vs. placebo) of NG infection were 0.77 (P = NS), 1.07 (P = NS), and 0.49 (P = 0.05) at the first, second, and third follow-up visits, respectively. PAT neither reduced significantly CT prevalence or HIV incidence among FSWs nor NG/CT prevalence among their clients. Conclusion: The only beneficial impact of PAT was on the prevalence of gonococcal infections among FSWs 9 months after the beginning of the intervention. Although PAT could be more effective in other circumstances, for instance, in the early stages of a program for FSWs, it can not be recommended at present as a routine strategy to control cervical infections among FSWs.
引用
收藏
页码:253 / 259
页数:7
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