O16.3 High prevalence of sexually transmitted infections among young African women in REACH study of oral emtricitabine-tenofovir and dapivirine vaginal ring

Abstract

<h3>Background</h3> With antiretroviral (ARV)-based HIV prevention, the hidden epidemic of sexually transmitted infections (STIs) is being uncovered. Most STIs are asymptomatic and not treated by syndromic case management, the standard of care in Africa. There are limited data on STI prevalence among African adolescent girls and young women (AGYW) who are at risk for sequelae from untreated STIs. <h3>Methods</h3> MTN-034/REACH is a randomized, open label, crossover study assessing the safety of and adherence to the dapivirine vaginal ring and oral emtricitabine-tenofovir in Cape Town and Johannesburg, South Africa, Kampala, Uganda and Harare, Zimbabwe. Sexually active HIV-negative AGYW ages 16–21 years were enrolled and tested for Chlamydia trachomatis/Neisseria gonorrhoeae (CT/GC) by nucleic acid amplification, Trichomonas vaginalis (TV) by rapid test, and syphilis by serology. AGYW with positive test results received treatment. Descriptive statistics were used to summarize STI prevalence at baseline and selected characteristics by STI status. <h3>Results</h3> Among 247 AGYW enrolled in REACH, 34% were 16–17 years old, 87% single, and the median number of sexual partners in the prior 3 months was 1 (IQR 1–2). At enrollment, 87 (35%) tested positive for any STI with 17 (7%) with &gt;1 STI: 71 (29%) for CT, 21 (8.5%) for GC, 12 (4.9%) for TV and 6 (2.4%) for syphilis. Of AGYW diagnosed with an STI, 90% were asymptomatic. The prevalence of any STI varied by site: 47% in Cape Town, 37% in Johannesburg, 32% in Kampala, and 25% in Harare. STI prevalence was higher among 18–21 year olds versus 16–17 year olds (37% vs 32%). <h3>Conclusion</h3> STI prevalence among AGYW initiating oral or topical PrEP was alarmingly high and most were asymptomatic, highlighting the limitations of syndromic STI management. There is an urgent need and imperative to provide diagnostic STI testing to AGYW with the delivery of HIV prevention methods.