Determinants of the Impact of Sexually Transmitted Infection Treatment on Prevention of HIV Infection: A Synthesis of Evidence from the Mwanza, Rakai, and Masaka Intervention Trials

摘要: Community-randomized trials in Mwanza, Tanzania, and Rakai Masaka, Uganda, suggested that population characteristics were an important determinant of the impact sexually transmitted infection (STI) treatment interventions on incidence human immunodeficiency virus (HIV) infection. We performed simulation modeling HIV STI transmission, which confirmed low trial Masaka could be explained by prevalences curable resulting from lower-risk sexual behavior Uganda. The mature epidemics with most transmission occurring outside core groups high rates, also contributed to incidence. Simulated was much greater although observed larger than predicted reductions, suggesting random error may have played some role. Of proposed alternative explanations, increasing herpetic ulceration due HIV-related immunosuppression little diminishing antibiotic during Ugandan epidemics. strategy unimportant, since syndromic annual mass showed similar effectiveness simulations each population. In conclusion, epidemic explain limited Uganda 1990s. populations high-risk STIs contribute substantially prevention