RHL Commentary by Kenneth F. Schulz
EVIDENCE SUMMARY
The Cochrane Reviewers conclude that limited evidence from randomized controlled trials indicates that Sexually transmitted infection (STI) control serves as an effective HIV prevention strategy. Evidence from a cluster randomized controlled trial in Mwanza, United Republic of Tanzania, suggests that control of sexually transmitted infections (STIs) is an effective strategy for the prevention of HIV under certain conditions (1). In particular, in an environment characterized by an emerging HIV epidemic, where STI treatment services were poor and where STIs were highly prevalent, improved STI treatment services were shown to reduce HIV transmission by about 40%. In other words, treatment of STIs can prevent HIV transmission, but these results may be specific to the types of conditions surrounding this trial in Mwanza.
Two other trials indicate no evidence for substantial benefit from STI treatment of all community members. In the cluster randomized trial in Rakai, Uganda, the reviewers found no evidence of substantial reductions in HIV transmission following mass treatment of all community members for STIs (2). The addition of a new trial in Masaka, Uganda (3) to the existing evidence supports the data from Rakai.
Evidence from all three trials suggests that STI control interventions reduce the prevalence and incidence of STIs and reproductive tract infections such as bacterial vaginosis. Indeed, all three trials displayed reduced levels of syphilis in the intervention communities.
The Cochrane reviewers used a comprehensive search strategy. They searched the trial registers of the Cochrane Infectious Diseases Group and Cochrane Collaborative Review Group on HIV Infections and AIDS. Furthermore, they searched the Cochrane Controlled Trials Register, MEDLINE and EMBASE. Two reviewers independently applied the inclusion criteria to potential studies, with any disagreements resolved by discussion.
I believe that they found all the trials pertaining to their search criteria. They seem to have used, however, a rather simplified analysis of the methodological quality of the trials.
The full RHL commentary also includes sections on: Relevance
- Magnitude of the problem
- Applicability of the results
- Implementation of the intervention
Research
References
This document should be cited as: Kenneth F. Schulz. Population-based interventions for reducing sexually transmitted infections, including HIV Infection: RHL commentary (last revised: 24 June 2004). The WHO Reproductive Health Library, No 9, Update Software Ltd, Oxford, 2006. www.rhlibrary.com
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