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3 Observational cohort of women at high risk for HIV in three urban settlements close to mines in North- West Tanzania Objectives: – To describe and quantify reported IVP – To investigate associations between IVP and HIV at the screening visit Background
Citation preview
Intravaginal practices in a cohort of women at high risk
in North-West Tanzania:
Baseline associations with HIV
Suzanna Francis, Tony Ao, Joseph Chilongani, Bahati Andrew, Deborah Watson-Jones, Saidi Kapiga, Richard
Hayes
Funded by the UK British Medical Research Council (MRC) and the European and Developing Countries Clinical Trials Partnership (EDCTP)
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Intravaginal practices (IVP): cleansing and insertion
IVP are highly prevalent among women in many parts of sub-Saharan Africa
Meta-analysis concluding that some types of IVP are a risk factor for HIV infection
IVP may affect the impact of female controlled HIV prevention methods, such as vaginal microbicides
Why are we interested in IVP?
3
Observational cohort of women at high risk for HIV in three urban settlements close to mines in North- West Tanzania
Objectives:– To describe and quantify reported IVP– To investigate associations between IVP and HIV at
the screening visit
Background
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Screening visits: Aug 2008 to Aug 2009 Study population: Women at high risk
– Food vendors– Restaurant / grocery workers– Bar, disco, local brew sellers– Guesthouse / hotel workers
N = 1,800 Screening visit had a face to face questionnaire and
HIV testing
Methods
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Overall HIV Prevalence 21%
HIV Prevalence by occupation– Food vendors 11%
– Restaurant / grocery workers 17%– Bar, disco, local brew sellers 33%– Guesthouse / hotel workers 39%
Results
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Percentage of women reporting IVP
0%
20%
40%
60%
80%
100%
Cleansing Insertion
Description of reported IVP in the past 3 months
7
Substances used for cleansing
0%
20%
40%
60%
80%
No cleansing Water only Soap or soapywater
Other
Description of reported IVP in the past 3 months
8
Application methods used for cleansing
0%
20%
40%
60%
80%
No cleansing Fingers only Cloth Cotton, paper,other
Description of reported IVP in the past 3 months
9
Frequency of cleansing
0%
10%
20%
30%
40%
Nocleansing
< daily x1/ day x2/ day x3/ day ≥4/ day
Description of reported IVP in the past 3 months
10
Type of substance inserted
0%
5%
10%
15%
20%
Anyinsertion
Herbs ortraditionalmedicine
Detergent Lemon Gels Other
Description of reported IVP in the past 3 months
11
Unadjusted associations between IVP and HIV
IVP Type HIV+/Total(%) OR (95% CI)Cleansing 353/1,579 (22%) 1.8 (1.2–2.7)
- water only with fingers 57/264 (22%) 1.7(1.0-2.8)
- water & soap with fingers 252/1,107 (23%) 1.8 (1.2-2.8)
- cloth 25/143 (18%) 1.3 (0.7-2.3) - cotton, paper, other 15/47 (32%) 2.8 (1.4-5.9)No cleansing 27/192 (14%) 1
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Unadjusted associations between IVP and HIV
IVP Type HIV+/Total(%) OR (95% CI)Cleansing 353/1,579 (22%) 1.8 (1.2–2.7)
- < once daily 6/43 (14.0%) 1.0 (0.4-2.5)- x1 / day 29/147 (19.7%) 1.5 (0.8-2.6)- x2 / day 144/652 (22.1%) 1.7 (1.1-2.7)- x3 / day 125/530 (23.6%) 1.9 (1.2-2.9)- +4 / day 45/182 (24.7%) 2.0 (1.2-3.4)
No cleansing 27/192 (14%) 1p-trend = 0.002
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Unadjusted associations between IVP and HIV
IVP Type HIV+/Total(%) OR (95% CI)Insertion 73/276 (26.5%) 1.3 (1.0–1.9)
- Herbs 27/102 (26.5%) 1.3 (0.9-2.1)- Detergent 24/93 (25.8%) 1.3 (0.8-2.1)- Lemon 5/29 (17.2%) 0.8 (0.3-2.0)- Gels 26/93 (27.5%) 1.4 (0.9-2.3)- Other 8/31 (25.8%) 1.3 (0.6-2.9)
No insertion 307/1,492 (20.6%) 1
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Adjusted associations between IVP and HIV
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IVP type Unadjusted Adjusted*Insertion 1.3 (1.0–1.9) 1.3 (0.9-1.7)Cleansing 1.8 (1.2–2.7) 1.5 (1.0-2.3)
- water only with fingers 1.7(1.0-2.8) 1.4 (0.8-2.3)
- water & soap with fingers 1.8 (1.2-2.8) 1.5 (1.0-2.4)
- cloth 1.3 (0.7-2.3) 1.3 (0.7-2.3)- cotton, paper,
other 2.8 (1.4-5.9) 2.7 (1.2-5.7)
No cleansing 1 1* Age group, employment, and number of sex partners in the last
three months as these were independently associated with prevalent HIV
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Adjusted associations between IVP and HIV
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IVP type Unadjusted Adjusted*Cleansing 1.8 (1.2–2.7) 1.5 (1.0-2.3)
- < once daily 1.0 (0.4-2.5) 0.9 (0.3-2.3)- x1 / day 1.5 (0.8-2.6) 1.2 (0.7-2.2)- x2 / day 1.7 (1.1-2.7) 1.5 (0.9-2.3)- x3 / day 1.9 (1.2-2.9) 1.7 (1.1-2.7)- +4 / day 2.0 (1.2-3.4) 1.7 (1.0-2.3)
No cleansing 1 1* Age group, employment, and number of sex partners in the last
three months. Adjusted p-trend = 0.006
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Most common type of IVP is cleansing with soap and fingers
Evidence of an association between cleansing and prevalent HIV
Strong evidence of a dose-response with frequency of cleansing and prevalent HIV
Some evidence of an association between insertion and prevalent HIV
Summary
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Baseline, cross-sectional analysis Small numbers reporting some types of IVP Possible reporting bias Limited variables to assess confounding as
there was no other STI testing or physical examination
Limitations
18
Incidence analysis combining data from Tanzanian sites and our sister site in Kampala, Uganda
Diary study in both Tanzania and Uganda describing the patterns of IVP behavior in more detail
Future work
19
The participants in the study
Study teams and team leaders in Geita, Shinyanga, and Kahama
Data team lead by Clemens Masesa
Laboratory staff lead by Aura Andreasen and John Changalucha
Acknowledgements