{
  "abstract": "Background HIV pre-exposure prophylaxis (PrEP) programmes in Africa reach young women at risk of sexually transmitted infections (STIs). We evaluated curable STI prevalence, incidence and risk factors among women initiating PrEP.Methods From August to December 2022, sexually active women aged 16–30 years from 15 South African sites, and one site each in Eswatini, Kenya, Malawi, Uganda and Zambia were enrolled into the INSIGHT cohort and offered oral emtricitabine/tenofovir PrEP with follow-up at 1, 3 and 6 months. At each visit, STI symptoms were assessed and treatment provided based on syndromic management or diagnostic testing. Diagnostic tests included nucleic acid amplification for Chlamydia trachomatis and Neisseria gonorrhoeae, the rapid OSOM for Trichomonas vaginalis at enrolment and month 6, and serological testing for syphilis at enrolment using rapid plasma reagin with confirmatory Treponema pallidum particle agglutination. Prevalence and incidence of each STI were calculated, and predictors assessed using multivariable regression.Results Of 3087 participants offered daily oral PrEP with a median age of 23 (IQR 21–27), 3011 had STI results and 30.9% had one or more STIs, with 15.7% reporting symptoms. The prevalence of C. trachomatis, N. gonorrhoeae, T. vaginalis and syphilis was 20.8%, 6.8%, 6.0% and 4.4%, respectively. The incidence of one or more STIs (C. trachomatis, N. gonorrhoeae or T. vaginalis) was 49.3/100 person-years (95% CI 45.3 to 53.4) with 12.7% reporting symptoms. The incidence of C. trachomatis was 30.6/100 person-years (95% CI 27.5 to 33.7), N. gonorrhoeae 10.8/100 person-years (95% CI 9.0 to 12.6) and T. vaginalis 11.5/100 person-years (95% CI 9.7 to 13.4). An incident STI diagnosis was associated with low alcohol use (adjusted incidence rate ratio (aIRR) 1.3; 95% CI 1.0 to 1.6) and moderate alcohol use (aIRR 1.4; 95% CI 1.1 to 1.8), and having an STI diagnosed at enrolment (aIRR 1.8; 95% CI 1.5 to 2.1).Conclusion The high prevalence and incidence of STIs among African women initiating PrEP, most of whom did not report symptoms, highlights the need for aetiologic testing to detect STIs, guide treatment and reduce reproductive health sequelae and risk of transmission.Trial registration number clinicaltrials.gov NCT05746065.",
  "authors": [
    {
      "affiliations": [
        "Department of Global Health, University of Washington, Seattle, Washington, USA"
      ],
      "name": "Irene Mukui"
    },
    {
      "affiliations": [
        "Department of Global Health, University of Washington, Seattle, Washington, USA"
      ],
      "name": "Sue Peacock"
    },
    {
      "affiliations": [
        "Department of Global Health, University of Washington, Seattle, Washington, USA",
        "Fred Hutchinson Cancer Center, Seattle, Washington, USA"
      ],
      "name": "Deborah Donnell"
    },
    {
      "affiliations": [
        "Makerere University-Johns Hopkins University Research Collaboration, Kampala, Central Region, Uganda"
      ],
      "name": "Brenda Gati-Mirembe"
    },
    {
      "affiliations": [
        "Department of Global Health, University of Washington, Seattle, Washington, USA"
      ],
      "name": "Meighan Krows"
    },
    {
      "affiliations": [
        "Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya"
      ],
      "name": "Elizabeth A Bukusi"
    },
    {
      "affiliations": [
        "Johns Hopkins Research Project-Kamuzu University of Health Sciences, Blantyre, Malawi"
      ],
      "name": "Loveness Imaan"
    },
    {
      "affiliations": [
        "Qhakaza Mbokodo Research Clinic, Ladysmith, South Africa"
      ],
      "name": "Philip Kotze"
    },
    {
      "affiliations": [
        "Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, Western Cape, South Africa"
      ],
      "name": "Katherine Margaret Gill"
    },
    {
      "affiliations": [
        "Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, Western Cape, South Africa"
      ],
      "name": "Pippa Macdonald"
    },
    {
      "affiliations": [
        "Madibeng Centre for Research, Brits, South Africa"
      ],
      "name": "Cheryl Louw"
    },
    {
      "affiliations": [
        "Wits Maternal Adolescent and Child Health Research, Durban, South Africa"
      ],
      "name": "Manjeetha Jaggernath"
    },
    {
      "affiliations": [
        "Perinatal HIV Research Unit HIV Prevention Clinical Research Site, University of the Witwatersrand, Soweto, South Africa"
      ],
      "name": "Anita Marais"
    },
    {
      "affiliations": [
        "Foundation for Professional Development, Research Unit, East London, Pretoria, South Africa"
      ],
      "name": "Remco P H Peters"
    },
    {
      "affiliations": [
        "Wits RHI, University of the Witwatersrand, Hillbrow, Johannesburg, South Africa"
      ],
      "name": "Sinead Delany-Moretlwe"
    },
    {
      "affiliations": [
        "Vuka Research Clinic, Department of Medicine, University of Cape Town, Cape Town, South Africa"
      ],
      "name": "Amy Ward"
    },
    {
      "affiliations": [
        "Vuka Research Clinic, Department of Medicine, University of Cape Town, Cape Town, South Africa"
      ],
      "name": "Phillip du Preez"
    },
    {
      "affiliations": [
        "University of North Carolina Global Projects Zambia, Lusaka, Zambia"
      ],
      "name": "Margaret Kasaro"
    },
    {
      "affiliations": [
        "Department of Medicine, University of California, San Francisco, San Francisco, California, USA"
      ],
      "name": "Monica Gandhi"
    },
    {
      "affiliations": [
        "Department of Medicine, University of Alabama, Birmingham, Alabama, USA"
      ],
      "name": "Renee Heffron"
    },
    {
      "affiliations": [
        "Department of Global Health, University of Washington, Seattle, Washington, USA",
        "Department of Epidemiology, University of Washington, Seattle, Washington, USA"
      ],
      "name": "Connie Celum"
    },
    {
      "affiliations": [],
      "name": "On behalf of the INSIGHT Study Team"
    }
  ],
  "title": "High prevalence and incidence of curable sexually transmitted infections among young women using oral HIV pre-exposure prophylaxis in sub-Saharan Africa: results from the INSIGHT Cohort study",
  "uid": "9d9f4b74-a059-573c-add3-1ea9ebc08762"
}