Background: The management of sexually transmitted infections (STI) is insufficiently addressed among African HIV-infected populations. We assessed STI prevalence and associated factors in HIV-positive women of reproductive age on antiretroviral therapy (ART) enrolled in a cohort study integrating reproductive health (RH) services into HIV care at two clinics in Abidjan.
Methods: We selected cohort participants aged 18-49 years, not pregnant, and on ART since less than 24 months. In 2017, socio-demographic and RH characteristics were collected using questionnaires. Collected blood samples and endocervical swabs were tested for Chlamydia trachomatis (CT), Mycoplasma genitalium (MG), Trichomonas vaginalis (TV), Neisseria gonorrhoeae (NG), Candida albicans (CA), syphilis, herpes (HSV), and bacterial vaginosis (BV). Risk factors were identified with adjusted logistic regression.
Results: Overall, 431 women were included. Median age was 36 (interquartile range 31-40), median CD4 count was 371 cells/mm3 (IQR 227-508), and 23.6% received no formal education. Condom use was infrequent globally (26.9%, 116/431). Among women in a stable partnership (75.8%, 326/431), 22.5% (73/324) had an HIV-positive partner and 64.3% disclosed their HIV status to their partner. Women whose stable partner was HIV-negative were more likely to report using condoms regularly (42.2%, 46/109) than those whose partner was HIV-positive (20.5%, 15/73, p=0.005) or of unknown HIV status (26.4%, 38/144, p=0.009). Overall STI prevalence excluding BV was 36.9% (95% confidence interval: 32.3-41.4). Prevalences of CA, CT, and syphilis were 25.0% (95% CI: 20.9-29.2), 7.2% (95% CI: 4.2-9.6), and 2.3% (95% CI: 0.9-3.7). Prevalence of HSV and TV was below 1.0%. No cases of NG or MG were detected. BV prevalence was 50.8% (95% CI: 46.0-55.6). After adjusting for age, education, study site, and condom use, women with an HIV-positive partner were at a higher risk of STIs than single women or those whose partner''s HIV status was negative or unknown (adjusted odds ratio 2.1, 95% CI: 1.2-3.8).
Conclusions: There is an urgent need to integrate STI management into HIV care. Further investigation is needed to address the vulnerability of women in seroconcordant couples. Strategies for better male involvement in STI testing and management are necessary to ensure treatment efficacy.

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