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Meta-Analysis
. 2019 Dec 2;2(12):e1917134.
doi: 10.1001/jamanetworkopen.2019.17134.

Global Epidemiologic Characteristics of Sexually Transmitted Infections Among Individuals Using Preexposure Prophylaxis for the Prevention of HIV Infection: A Systematic Review and Meta-analysis

Jason J Ong  1   2 , Rachel C Baggaley  3 , Teodora E Wi  3 , Joseph D Tucker  1 , Hongyun Fu  4 , M Kumi Smith  5 , Sabrina Rafael  1 , Vanessa Anglade  1 , Jane Falconer  1 , Richard Ofori-Asenso  2 , Fern Terris-Prestholt  1 , Ioannis Hodges-Mameletzis  3 , Philippe Mayaud  1
Affiliations
Meta-Analysis

Global Epidemiologic Characteristics of Sexually Transmitted Infections Among Individuals Using Preexposure Prophylaxis for the Prevention of HIV Infection: A Systematic Review and Meta-analysis

Jason J Ong et al. JAMA Netw Open. .

Abstract

Importance: Despite a global increase in sexually transmitted infections (STIs), there is limited focus and investment in STI management within HIV programs, in which risks for STIs are likely to be elevated.

Objective: To estimate the prevalence of STIs at initiation of HIV preexposure prophylaxis (PrEP; emtricitabine and tenofovir disoproxil fumarate) and the incidence of STIs during PrEP use.

Data sources: Nine databases were searched up to November 20, 2018, without language restrictions. The implementers of PrEP were also approached for additional unpublished data.

Study selection: Studies reporting STI prevalence and/or incidence among PrEP users were included.

Data extraction and synthesis: Data were extracted independently by at least 2 reviewers. The methodological quality of studies was assessed using the Joanna Briggs Institute critical assessment tool for prevalence and incidence studies. Random-effects meta-analysis was performed.

Main outcomes and measures: Pooled STI prevalence (ie, within 3 months of PrEP initiation) and STI incidence (ie, during PrEP use, after 3 months).

Results: Of the 3325 articles identified, 88 were included (71 published and 17 unpublished). Data came from 26 countries; 62 studies (70%) were from high-income countries, and 58 studies (66%) were from programs only for men who have sex with men. In studies reporting a composite outcome of chlamydia, gonorrhea, and early syphilis, the pooled prevalence was 23.9% (95% CI, 18.6%-29.6%) before starting PrEP. The prevalence of the STI pathogen by anatomical site showed that prevalence was highest in the anorectum (chlamydia, 8.5% [95% CI, 6.3%-11.0%]; gonorrhea, 9.3% [95% CI, 4.7%-15.2%]) compared with genital sites (chlamydia, 4.0% [95% CI, 2.0%-6.6%]; gonorrhea, 2.1% [95% CI, 0.9%-3.7%]) and oropharyngeal sites (chlamydia, 2.4% [95% CI, 0.9%-4.5%]; gonorrhea, 4.9% [95% CI, 1.9%-9.1%]). The pooled incidence of studies reporting the composite outcome of chlamydia, gonorrhea, and early syphilis was 72.2 per 100 person-years (95% CI, 60.5-86.2 per 100 person-years).

Conclusions and relevance: Given the high burden of STIs among individuals initiating PrEP as well as persistent users of PrEP, this study highlights the need for active integration of HIV and STI services for an at-risk and underserved population.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Ong reported receiving a research grant from the World Health Organization during the conduct of the study. Dr Baggaley reported receiving grants from Unitaid during the conduct of the study and grants from Unitaid outside the submitted work. Ms Rafael reported receiving personal fees from the London School of Tropical Medicine and Hygiene during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. PRISMA Flowchart
PrEP indicates preexposure prophylaxis.
Figure 2.
Figure 2.. Countries That Provided Data for the Systematic Review
See this image and copyright information in PMC

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