Abstract
IntroductionCurrent global helminth control guidelines focus on regular deworming of targeted populations for morbidity control. However, water, sanitation, and hygiene (WASH) interventions may also be important for reducing helminth transmission. We evaluated the impact of different potential helminth protective packages on infection prevalence, including repeated treatment with albendazole and praziquantel with and without WASH access.Methodology/Principal findingsWe conducted a cohort study nested within a randomized trial of empiric deworming of HIV-infected adults in Kenya. Helminth infections and infection intensity were diagnosed using semi-quantitative real-time PCR. We conducted a manual forward stepwise model building approach to identify if there are packages of interventions that may be protective against an STH infection of any species (combined outcome) and each helminth species individually. We conducted secondary analyses using the same approach only amongst individuals with no anthelmintis exposure. We used interaction terms to test for potential intervention synergy. Approximately 22% of the 701 stool samples provided were helminth-infected, most of which were of low to moderate intensity. The odds of infection with any STH species were lower for individuals who were treated with albendazole (aOR:0.11, 95%CI: 0.05, 0.20, p<0.001), adjusting for age and sex. Although most WASH conditions demonstrated minimal additional benefit in reducing the probability of infection with any STH species, access to safe flooring did appear to offer some additional protection (aOR:0.34, 95%CI: 0.20, 0.56, p<0.001). For schistosomiasis, only treatment with praziquantel was protective (aOR:0.30 95%CI: 0.14, 0.60, p = 0.001). Amongst individuals who were not treated with albendazole or praziquantel, the most protective intervention package to reduce probability of STH infections included safe flooring (aOR:0.34, 95%CI: 0.20, 0.59, p<0.001) and latrine access (aOR:0.59, 95%CI: 0.35, 0.99, p = 0.05). Across all species, there was no evidence of synergy or antagonism between anthelmintic chemotherapy with albendazole or praziquantel and WASH resources.Conclusions/SignificanceDeworming is effective in reducing the probability of helminth infections amongst HIV-infected adults. With the exception of safe flooring, WASH offers minimal additional benefit. However, WASH does appear to significantly reduce infection prevalence in adults who are not treated with chemotherapy.Trial registrationClinicalTrials.gov, NCT00507221.
Highlights
Using data from a randomized controlled trial of deworming among HIV-infected adults in Kenya, we evaluated the associations between different potential packages of deworming and WASH interventions with helminth prevalence
Of the 740 individuals who participated in Helminth Eradication to delay ART Trial (HEAT), stool samples were available from 701 individuals
In this study there was no evidence of additional benefit associated with access to more than one WASH resource when combined with chemotherapy
Summary
Study design and populationWe conducted a retrospective cohort study nested within the Helminth Eradication to delay ART Trial (HEAT) [20]. Individuals were eligible for inclusion if they were 18 years of age or older, were HIV seropositive, were not pregnant at the time of enrollment, and did not meet current criteria for ART initiation (on the basis of documented WHO disease stage and CD4+ cell count within the previous 3 months and a clinical assessment at enrollment). Stool aliquots of approximately 1 gram were placed in cryotubes and frozen at −80 ̊C for subsequent DNA extraction and examination at the Leiden University Medical Center (the Netherlands). For this analysis, intensity of helminth infections was assessed by PCR only
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