Burden of Sexually Transmitted Infections STIs and Prevalence
Burden of Sexually Transmitted Infections (STIs) and Prevalence of HIV among Key Population Individuals Presenting with STIs in Nepal Dr. Durga Prasad Bhandari, Khagendra KC, Ram Khoju, Kiran Bam, Bharat Shrestha, Pradeep Thakur, Indu Adhikary, Bhagawan Shrestha FHI 360, LINKAGES Nepal AIDS 2018 July 25, 2018 Amsterdam, The Netherlands
Background • Globally, relatively little attention has been devoted to sexually transmitted infections (STIs). • Nearly 1 million people get infected every day with any of four curable STIs: chlamydia, gonorrhea, syphilis, and trichomoniasis. • Use of biomedical prevention methods (antiretroviral therapy, pre-exposure prophylaxis, post-exposure prophylaxis) may affect behavioral patterns and condom use, leading to increased STIs.
Overview of HIV Epidemic in Nepal • Concentrated HIV epidemic • Estimated HIV prevalence: 0. 15% • Key populations (KPs) at risk of HIV: – Female sex workers (FSWs), clients of FSWs – People who inject drugs (PWID) – Men who have sex with men (MSM), male sex workers (MSWs), transgender (trans) people – Male labor migrants • Committed to meeting UNAIDS goals of 90 -90 -90 by 2020 and ending AIDS epidemic as public health threat by 2030
HIV and STI Situation in Nepal HIV Epidemic Zones Kathmandu Valley Pokhara Terai Highway Districts FSW Prevalence % HIV Syphilis 2. 2 MSM and Trans People Prevalence % HIV Syphilis 6. 2 1. 5 0. 3 0 2. 2 0. 3 0. 85 10. 3 8. 2 9. 4 Proportion of patients visiting government outpatient clinics who have an STI*: 0. 62% Sources: NCASC. Factsheet: HIV surveillance, Nepal. 2017. Available from: https: //www. ncasc. gov. np/WAD 2017/; Department of Health Services, Nepal. Annual report, 2016/2017.
LINKAGES Nepal (1/2) • Stands for the Linkages across the Continuum of HIV Services for Key Populations Affected by HIV project, USAID and PEPFAR’s flagship project addressing HIV prevention, care, and treatment among key populations • Being implemented in 16 districts in Nepal, October 2016–June 2019 • Provides HIV and STI prevention, diagnosis, and case management services to FSWs, clients of FSWs, MSM, MSWs, and trans people • Offers all individuals presenting for STI services HIV testing and vise versa
LINKAGES Nepal (2/2) • Closely coordinates and collaborates with government • Is represented in national HIV technical working groups • Obtains all diagnostic test kits, reagents, and medicines from the national logistics system • Actively links people living with HIV (PLHIV) identified in LINKAGES clinics with government ART centers for treatment • Follows up PLHIV in the community through peer navigators
STI Case Management in LINKAGES Nepal Includes: • Demand generation in community • Counseling and syndromic management in clinics • Syphilis screening and treatment with benzathine penicillin • Condom distribution • Presumptive treatment of cervicitis (for FSWs only) • Health care waste management
Burden of STIs and Prevalence of HIV (October 2016 -September 2017) Total KP individuals screened for STIs: 23, 454 Total STI cases identified: 5, 475 Total HIV cases identified among STI patients: 42 (0. 7%) 69. 3% (Figures in light blue boxes represent HIV prevalence) 13. 3% Sy ph ili s 9. 9% UD S V 0. 7% HS tis ici Ce rv DS 3. 7% GW 1. 3% 0. 5% GU PI VD D 1. 4% 2. 9% 0. 2% 2. 0% S 80. 0% 70. 0% 60. 0% 50. 0% 40. 0% 30. 0% 20. 0% 10. 0% 0. 4% Note: VDS = vaginal discharge syndrome; PID = pelvic inflammatory disease (lower abdominal pain syndrome); GUDS = genital ulcer disease syndrome; GW = genital warts; HSV = herpes simplex virus; UDS = urethral disease syndrome
STI Burden among HIV-Positive Clients, N=42 (October 2016–September 2017) 38. 1% [VALUE] Vaginal discharge syndrome Urethral discharge syndrome 2. 4% Genital warts Syphilis
Conclusions • The STI burden among KP program beneficiaries is high, and many KP members living with HIV are co-infected with an STI. • Providing integrated services helps link a large number of KP individuals to needed STI services in this resource-limited setting. • All individuals presenting for HIV testing should be examined, tested, and treated for STIs and vice versa.
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Acknowledgments
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