Improved treatment services significantly reduce the prevalence of sexually transmitted diseases in rural Tanzania - results of a randomized controlled trial

Abstract

Objective: To evaluate the impact of improved case management for sexually transmitted diseases (STD) at the primary health care level on the incidence and prevalence of STD. Design: Community-randomized controlled trial. Setting: Mwanza region, Tanza ni a. Subjects: A random cohort of about 1000 adults aged 15- 54 years from each of12 communities, in six matched pairs. O ne member of each pair was assignee! at random to receive the intervention , and the others served as a comparison community. This cohort was surveyed at baseline and al follow-up 2 years later. About 100 antenatal clinic attenders were also studied in each community on two occasions: the first shortly afte1· the implementation of the intervention, and the second approximately 1 year later. Intervention : Improved services were established for the management of STD, using the syndromic approach, in rural health units. Results: A total of 12 534 individuals were enrolled in the cohort study, oi whom 8844 (7"1 'X,) were seen again 2 years later. The prevalence of serological syphilis · (rapid plasma reagin litre >1 :B, Treponema palidum haemagglubin assay positive) was 6.2% in both intervention and comparison communities al baseline. At followup it was 5.0% in the intervention community and 7.0% in the comparison community adjusted relative risk (RR), 0 .71; 95% confidence level,1 1 (C l ), 0.54 - 0 .93; P < 0.0 2 1. The prevalence of urethritis in males did not differ significantly between intervention and comparison groups al follow-up, but the prevalence of symptomatic urethritis was reduced by about 50% (adjusted RR , 0.51; 95% Cl, 0.24-1 .1 O; P = 0.08). There was no significant difference between the groups in the incidence of self-reported STD symptoms over the last year of the follow-up period, or in the prevalence of any STD in antenatal clinic attenders. Conclusion: The reduction in HIV incidence previously reported in this intervention study can be al attributed to a reduction in the duration, and hence the prevalence of symptomatic STD.