Antibody to Herpes Simplex Virus Type 2 as a Marker of Sexual Risk Behavior in Rural Tanzania

London School of Hygiene, Central Public Health Laboratory, London, United Kingdom.
The Journal of Infectious Diseases (Impact Factor: 6). 02/1999; 179(1):16-24. DOI: 10.1086/314555
Source: PubMed

ABSTRACT A serosurvey was conducted in a random sample of 259 women and 231 men in 12 rural communities in Mwanza Region, Tanzania, using a type-specific ELISA for Herpes simplex virus type 2 (HSV-2) infection. Seroprevalence rose steeply with age to approximately 75% in women >=25 years old and 60% in men >=30. After adjusting for age and residence, HSV-2 prevalence was higher in women who were married, in a polygamous marriage, Treponema pallidum hemagglutination assay (TPHA)-positive, had more lifetime sex partners, or who had not traveled. Prevalence was higher in men who were married, had lived elsewhere, had more lifetime partners, had used condoms, or were TPHA-positive. HSV-2 infection was significantly associated with recent history of genital ulcer. The association between HSV-2 infection and lifetime sex partners was strongest in those <25 years old in both sexes. This association supports the use of HSV-2 serology as a marker of risk behavior in this population, particularly among young people.

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    • "The limitations of self-reported sexual behavior data (Catania et al., 1990; Cleland et al., 2004; Helleringer et al., 2011; Morris, 2004; Obasi et al., 1999; Pisani et al., 2003), could be a key reason for the challenges encountered in these analyses. Our analysis provided a contextual support of a remarkable reduction in sexual risk behavior, but through an indirect approach rather than direct empirical data. "
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    ABSTRACT: Background: HIV prevalence is decreasing in much of sub-Saharan Africa (SSA), but the drivers of the decline are subject to much dispute. Using mathematical modeling as a tool for hypothesis generation, we demonstrate how the hypothesis that the drop in prevalence reflects declines in sexual risk behavior is self-consistent. We characterize these potential declines in terms of their scale, duration, and timing, and theorize on how small changes in sexual behavior at the individual-level could have driven large declines in HIV prevalence. Materials and methods: A population-level deterministic compartmental model was constructed to describe the HIV epidemics in 24 countries in SSA with sufficient trend data. The model was parameterized by national HIV prevalence and HIV natural history and transmission data. The temporal evolution of sexual risk behavior was characterized using established tools and uncertainty and sensitivity analyses on the results were conducted. Results: Declines in the scale of sexual risk behavior between 31.8% (Botswana) and 89.3% (Liberia) can explain the declining HIV prevalence across countries. The average decline across countries was 68.9%. The transition in sexual risk behavior lasted between 2.7 (Botswana) and 16.6 (Gabon) years with an average of 8.2 years. The turning point year of the transition occurred between 1993 (Burundi) and 2001 (Namibia), but clustered around 1995 for most countries. The uncertainty and sensitivity analyses affirmed our model predictions. Conclusion: The hypothesis that HIV prevalence declines in SSA have been driven by declines in sexual risk behavior is self-consistent and provides a convincing narrative for an evolving HIV epidemiology in this region. The hypothesized declines must have been remarkable in their intensity, rapidity, and synchronicity to explain the temporal trends in HIV prevalence. These findings provide contextual support for the hypothesis that changes in sexual behavior that materialized in the 1990s are a dominant driver of the recent decreases in HIV prevalence.
    Epidemics 09/2014; 8:9–17. DOI:10.1016/j.epidem.2014.06.001 · 1.87 Impact Factor
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    • "Unfortunately, currently available markers in vaginal fluids (Y-chromosome, semenogelin, prostate-specific antigen) do not reliably detect previous sex that occurred over 14 days prior to sample collection [47]. A serological marker of sexual exposure, such as herpes simplex virus type-2 (HSV-2) antibody [48] was not measured because of budget constraints, concerns that drawing a blood sample may have increased refusal rate, and because HSV-2 is not a gold standard for the detection of sexual debut [49]. Finally, self-administered vaginal swabs were collected rather than physician-collected endocervical specimens. "
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    ABSTRACT: Background. Human papillomavirus (HPV) vaccines are recommended for girls prior to sexual debut because they are most effective if administered before girls acquire HPV. Little research has been done on HPV prevalence in girls who report not having passed sexual debut in high HPV-prevalence countries. Methods. Using attendance registers of randomly selected primary schools in the Mwanza region of Tanzania, we enrolled girls aged 15–16 years who reported not having passed sexual debut. A face-to-face interview on sexual behavior and intravaginal practices, and a nurse-assisted self-administered vaginal swab were performed. Swabs were tested for 13 high-risk and 24 low-risk HPV genotypes. Results. HPV was detected in 40/474 (8.4%; 95% confidence interval [CI], 5.9–11.0) girls. Ten different high-risk and 21 different low-risk genotypes were detected. High-risk genotypes were detected in 5.3% (95% CI, 3.5–7.8). In multivariable analysis, only intravaginal cleansing (practiced by 20.9%) was associated with HPV detection (adjusted odds ratio = 2.19, 95% CI, 1.09–4.39). Conclusion. This cohort of adolescent Tanzanian girls had a high HPV prevalence prior to self-reported sexual debut, and this was associated with intravaginal cleansing. This most likely reflects underreporting of sexual activity, and it is possible that intravaginal cleansing is a marker for unreported sexual debut or nonpenetrative sexual behaviors.
    The Journal of Infectious Diseases 04/2014; 210(6). DOI:10.1093/infdis/jiu202 · 6.00 Impact Factor
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    • "• Sexual risk behaviour will be measured in the Population Cohort at each survey and used to assess whether there is behavioural disinhibition related to the intervention. This analysis will be supported by data collected in the Population Cohort on Herpes simplex virus, type 2 incidence, which has been shown to be a biomarker for sexual risk behaviour especially among young people [61-63]. "
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    ABSTRACT: Effective interventions to reduce HIV incidence in sub-Saharan Africa are urgently needed. Mathematical modelling and the HIV Prevention Trials Network (HPTN) 052 trial results suggest that universal HIV testing combined with immediate antiretroviral treatment (ART) should substantially reduce incidence and may eliminate HIV as a public health problem. We describe the rationale and design of a trial to evaluate this hypothesis. A rigorously-designed trial of universal testing and treatment (UTT) interventions is needed because: i) it is unknown whether these interventions can be delivered to scale with adequate uptake; ii) there are many uncertainties in the models such that the population-level impact of these interventions is unknown; and ii) there are potential adverse effects including sexual risk disinhibition, HIV-related stigma, over-burdening of health systems, poor adherence, toxicity, and drug resistance.In the HPTN 071 (PopART) trial, 21 communities in Zambia and South Africa (total population 1.2 m) will be randomly allocated to three arms. Arm A will receive the full PopART combination HIV prevention package including annual home-based HIV testing, promotion of medical male circumcision for HIV-negative men, and offer of immediate ART for those testing HIV-positive; Arm B will receive the full package except that ART initiation will follow current national guidelines; Arm C will receive standard of care. A Population Cohort of 2,500 adults will be randomly selected in each community and followed for 3 years to measure the primary outcome of HIV incidence. Based on model projections, the trial will be well-powered to detect predicted effects on HIV incidence and secondary outcomes. Trial results, combined with modelling and cost data, will provide short-term and long-term estimates of cost-effectiveness of UTT interventions. Importantly, the three-arm design will enable assessment of how much could be achieved by optimal delivery of current policies and the costs and benefits of extending this to UTT.Trial registration: NCT01900977.
    Trials 02/2014; 15(1):57. DOI:10.1186/1745-6215-15-57 · 1.73 Impact Factor
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