Background: HPTN071 (PopART) is a 3-arm community-randomized trial in 21 communities, 12 in Zambia and 9 in South Africa. The trial will determine the impact of a combination prevention intervention on HIV incidence. Community HIV care-providers (CHiPs) deliver the intervention to all households in intervention communities. Due to the close association between HIV and sexually transmitted infections (STIs) screening questions for symptomatic STIs are included as part of the intervention.
Methods: Verbal consent was obtained for individuals 18 years and older, with assent for those < 18. An STI screening tool was delivered by CHiPs to identify signs or symptoms suggestive of an STI (presence of genital sores/growth, vaginal/urethral discharge, dysuria, lower abdominal pains). All those screening positive were referred to the clinic for routine STI diagnosis and treatment. We present data for the period September 2016 to November 2017.
Results: Overall 94.8% of households (70,831/74,657) were enumerated, including total of 192,697 household members aged ≥15 years. 139,892 individuals consented to the intervention and 95.7% (133,985/139,892) were screened for STIs. Overall, among those screened, 1.3% (1,775/133,985) reported STI symptoms. Prevalence of STI symptoms was higher in South Africa 1.6% than Zambia 1.2% (p=0.0031), and commonest among the 20-24 age-group in South Africa (2.3%) and among 25-29 age-group in Zambia (1.7%). Prevalence was similar in both males and females in Zambia, but higher in females in South Africa (OR1.37, 95%CI 1.17-1.61). Those testing HIV-positive at this visit by the CHiPs were more likely to report STI-symptoms than those testing HIV-negative (OR3.9, 95%CI 2.8-5.3 in Zambia and OR4.4, 95%CI 3.6-5.5 in South Africa), and were also more likely to report symptoms than those who were already diagnosed with HIV previously (self-reported HIV). Individuals not previously known to have HIV and who declined testing at this visit had the lowest prevalence of STI symptoms (Table 1).
Conclusions: Large scale community-based STI symptom screening of individuals using a simple tool is acceptable and feasible. Symptoms of STIs were more common amongst young adults in both countries, and also in those newly identified with HIV. STI screening should be incorporated into community based HIV testing programs.



[Associated Factors of STI Symptoms]

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