Young women at high risk of STIs in Zimbabwe – Study

By Paul Sixpence

ONE in four young women in Zimbabwe is likely to be infected with a sexually transmitted infection (STI) – with odds higher in young women living with HIV, the STICH study has revealed.

The STICH study was conducted in Bulawayo and Harare by the Biomedical Research and Training Institute (BRTI).

Close to 10 000 youth between the ages of 16 and 24 years were enrolled into the study with over 8 500 (86%) accepting testing for chlamydia, gonorrhoea and trichomoniasis.

The STICH study was nested within CHIEDZA/UKUKHANYA a bigger trial that sought to “determine the impact of community-based integrated HIV and sexual and reproductive health services for youth on HIV and other health outcomes.”

Study results were published in August 2023 in the Lancet, a medical journal, demonstrating high uptake of STI testing, high STI prevalence in community settings, knowledge gaps in STI testing and diagnostics among youth.

“We observed a high STI prevalence among youth with almost one in four young women (23%) testing positive for either chlamydia, gonorrhoea or vaginalis (trichomoniasis) and 10% prevalence of chlamydia and gonorrhoea among males,” the research paper states.

The primary outcome of the trial was to assess the impact of STI testing and treatment on the population prevalence of STIs.

“Over the 12month intervention period, 10 691 youth (71.2% female) attended CHIEDZA/UKUKHANYA services in the eight intervention communities in Harare and Bulawayo,” reads the research report. “9891 unique eligible clients attended the service over the intervention period. Of these, 8549 (86.1%) clients accepted chlamydia / gonorrhoea testing.”

Research indicates that adolescents and young people aged 10–24 years are at high risk of HIV and STIs. One of the secondary study outcomes sought to measure STI prevalence.

“The prevalence of chlamydia and gonorrhoea was 14.7% and 2.8% respectively. The prevalence of chlamydia and gonorrhoea was twice as high in females than males. The combined prevalence of chlamydia, gonorrhoea or trichomoniasis in women was 23.2%. In men, who were only tested for chlamydia and gonorrhoea, the combined prevalence of the two STIs was 9.8%.”

The study reported relatively high rates of STI treatment uptake.

“A total of 927 (60.7%) out of 1526 clients with a positive chlamydia or gonorrhoea test came to the site to collect their result and among them only three refused treatment,” the study advised.

However, the majority of partners to clients who tested positive did not return for treatment despite notification.

“In total 1807 clients tested positive for at least one of the three STIs (chlamydia, gonorrhoea or trichomoniasis) and were offered partner notification slips. Only for 103 (5.7%) did a partner return for treatment.”

Discussing research findings, STICH study researchers highlighted that the high uptake of STI testing services could be attributed to confidentiality, youth friendly services and provision of the service in non-clinical settings.

“The high uptake of STI testing observed in our study may have been due to the confidential nature of services and anonymised testing routinely offered as part of an integrated package of services. Providers were specifically trained to be non-judgemental and maintain confidentiality, and STI testing was embedded within an integrated package of broader health services offered in a community-based setting (multi-purpose community halls) which enabled young people to take up STI testing without fear of stigma from their peers, healthcare providers or communities,” STICH study researchers opined.

The study highlights the limitations of syndromic management of STIs, which refers to making clinical decisions based on a patient’s symptoms and signs, which remains the standard of care in Zimbabwe and other resource constrained settings despite World Health Organization (WHO) recommendations to move towards diagnostic approaches for STI management.

“More than 70% of curable STIs are asymptomatic and thus not identified or treated, facilitating continued transmission and impeding STI control,” the study further notes.

In July 2023 at the STI and HIV World Congress, WHO called for better access to testing and diagnostic services. The world public health body also sounded alarm on antimicrobial resistance (AMR) in gonorrhoea.

At present and in the absence of point of care testing and diagnostics technologies, Dr. Chido Dziva Chikwari an epidemiologist and researcher in the STICH and CHIEDZA/UKUKHANYA studies had the following words of advice to young people and the generality of the populace.

“In our setting testing for most STIs is not widely available, however, one of the best tools we have to prevent STIs at the moment are condoms and if they are use consistently and correctly do reduce the transmission of STIs.”

According to WHO’s 2022–2030 Global Health Sector Strategy on HIV, viral hepatitis and STIs, global prevalence of STIs remains high with more than one million infections per day of curable STIs – namely – syphilis, gonorrhoea, chlamydia and trichomoniasis.

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