Abstract Book Vol. 1 [International Conference on AIDS (16th: 2006: Toronto, Canada)]

significantly so in Lai Chau province from 1.0% to 14.1%. Multivariate analysis
showed a significant decrease in NG/CT (OR=0.53, p=0.000), NG (OR=0.27,
p=0.000), and increase in syphilis (OR=1.53, p=0.014).
Conclusions: Implementation of the project was associated with a reduction
in GC/CT infections in FSWs, more so with GC compared with CT. A marked
increase in syphilis in Lai Chau was identified. STI/HIV interventions in FSWs
can be implemented by government services and should be intensified and
expanded to other provinces.
TUPE0411
Recent onset of STI symptoms, actions to prevent
transmission and symptom management in
low-income, socially marginalized populations in
urban, coastal Peru
A.G. Lescano', K.A. Konda2, J.L. Clark2, J. Galea2, J.D. Klausner', FR. Jones4,
S.R. Leons, C.F. Caceres', T.J. Coates2, The NIMH Collaborative HIV/STD
Prevention Trial Group. 'US Naval Medical Research Center Detachment
(NMRCD), Lima, Peru, 'University of California, Los Angeles, David Geffen
School of Medicine, Los Angeles, United States, 3San Francisco Department
of Public Health, San Francisco, United States, 4US Naval Medical Research
Center, Silver Spring, United States, sUniversidad Peruana Cayetano Heredia,
Facultad de Salud Publica y Administracion, Lima, Peru
Background: Disclosure of infection status to partners and inadequate
response to syndromes is a major obstacle for STI prevention and control.
Methods: During an epidemiological survey of three low-income, socially
marginalized populations in urban, coastal Peru (2001-2), we studied the
occurrence of STI symptoms and the actions taken by symptomatic individuals
to prevent further transmission. Participants were questioned about the
presence of urethral/vaginal secretions or discharge and genital ulcers in the
last six months, and their response to these symptoms. No questions were
made regarding rectal symptoms. The survey also evaluated sexual risk
behavior while urine/serologic tests determined STI/HIV infection prevalence.
Results: The study sample included 1197 individuals: 922 young males, 168
men who have sex only with men (MSOM) and 107 young females. Urethral/
vaginal discharge was reported more frequently (p<0.001) by females
(56.1%) than by males and MSOM (5.6% and 4.8%, respectively). Genital
ulcers were less frequent in MSOM (7.7% versus 13.1%/14.9% in males/
females respectively, p=0.043). Only 36.7% of subjects with discharge told
their partners (males=25.0%, MSOM=0%, females=51.7%, p=0.001),
56.7% continued having sex (males=42.3%, MSOM=62.5%, females=68.3%,
p=0.019) and 53.3% tried to cure symptoms. Regarding ulcers, 34.7% of
cases told their partners (males=31.4%, MSOM=23.1% and females=68.8%,
p=0.012), 43.6% continued having sex and 59.3% tried to treat their symptoms
(males:54.6%, MSOM:69.2%, females:87.5%, p=0.031). Among subjects that
continued having sex, more than half tried to prevent transmission to partners
(58.8% for discharge and 55.6% for ulcers), most of them with either home
remedies or drugs (47.5% to 62.5%) and fewer wearing condoms (16.7% and
27.5%). Response actions started approximately 3 days (median) after the
onset of symptoms.
Conclusions: STI symptoms are frequent in socially marginalized populations
in urban, coastal Peru, and disclosure to partners is uncommon. Interventions
need to reinforce prompt symptom recognition and treatment, as well as and
condom use or abstinence while symptoms are present.
TUPEO412
Syndromic management training for informal care
providers in Pakistan improves quality of STD care:
a randomized clinical trail
S.A. Shah', S. Kristensen2, A. Mirza3, Q. Abbas4, S.H. Vermund'. 'Dow
University of Health Sciences, Planning and Development, Karachi, Pakistan,
2University of Alabama Birmingham, Mother and Child Health, Karachi,
Pakistan, 3Bridge, Karachi, Pakistan, 45indh AIDS Control Program, Karachi,
Pakistan, 'University of Vanderbilt, Epidemiology, Nashville, United States
Background: Informal care providers are community-based, unlicensed
private medical practitioners without formal medical training, who provide care
or treatment for sexually transmitted diseases (STD) to many men in Pakistan.
We hypothesized that training in syndromic management of this important group
of providers could improve the quality of STD services available in Pakistan.
Methods: We conducted a randomized, controlled three-armed trial of tailored
syndromic case management training workshops with informal health care
providers in three cities of Pakistan. The design included intervention Groups
A and B (training workshops for non-formal providers, without and with
provision of 60 days supplies of STDs syndromic packets) compared to Group
C (the control; informal providers receiving only basic information about STD
management).
Results: Quality of STD case management service observed by "incognito"
patients" in both the intervention groups improved substantially compared
to control group (p<0.05). Group B (with free syndrome packets) performed

better in service delivery, HIV testing referral, and condoms provision (p<0.05)
as compared to Group A (no packets). Group B retained more knowledge and
practiced more skillfully 6-months post-interventions. Exit interviews of clients
revealed greater proportions of providers in both interventions groups offering
advice on condom use (80%) than providers in the control group.
Conclusions: Syndromic management training among informal health care
providers substantially improved the quality of STD care services. Provision of
free syndrome packets was well received and substantially enhanced adherence
to ideal practices among the trained providers.

TUPEO413
Baseline screening and risk factors for HIV and
HSV-2 in an HSV-2 suppressive treatment trial in
Tanzania
D. Watson-Jones', J. Changalucha2, H. Weiss3, K. Baisley2, C. Claire2,
D. Everett', D. Rossi, R. Hayes3, M. Rusizoka'. 'African Medical & Research
Foundation, Mwanza, Tanzania, United Republic of, 2National Institute for
Medical Research, Mwanza, Tanzania, United Republic of, 3London School of
Hygiene & Tropical Medicine, Dept. of ITD, London, United Kingdom
Background: The effect of HSV suppressive therapy on HIV incidence, and
on HSV-2 and HIV genital viral shedding is being evaluated among high risk
women in Tanzania. Baseline screening results for HIV and HSV-2 and risk
factors for these infections are described.
Methods: Female bar, hotel and other facility workers in NW Tanzania are being
enrolled into a double-blind, placebo-controlled trial of HSV-2 suppressive
therapy with aciclovir 400mg bd. Following community information, mobilisation
and mapping of food and recreational facilities, a baseline survey to screen for
antibodies to HSV-2 and HIV in facility workers was conducted. Female facility
workers aged 16-35 years were invited to attend a mobile clinic to screen
for antibodies to HSV-2 and HIV. Exclusion criteria included self-reported
pregnancy, breastfeeding and mobility. Odds ratios and 95% confidence
intervals associated with HSV2 and HIV infection were estimated using multiple
logistic regression.
Results: Initial mapping of bars, hotels and other facilities within 21 high
transmission areas (truckstops and around goldmines) found 6212 women
working in 2564 facilities. During three screening rounds a total of 2735
women attended. Of the first 2113 women analysed to date, 79% were HSV2
seropositive and 30% were HIV seropositive. HSV2 positive women were more
likely to be HIV positive compared to HSV2 negative women (37% v.s. 9%
respectively; p<0.001). There were similar independent risk factors for HIV
and HSV2 infection, including older age, being widowed, being a bar worker
and having had more lifetime partners. HSV2 infection was also associated with
a lower level of education.
Conclusions: There is a high HSV and HIV prevalence in this population of
female facility workers and HIV infection is strongly associated with prevalent
HSV2 infection. These women are a suitable study population for a trial of HSV
suppressive therapy for HIV acquisition and transmission.
TUPEO414
Four cities modelling: #5 simulated effect of
HSV-2 prophylactic vaccines on population-level HIV
incidence in sub-Saharan Africa
E.E. Freeman', R.G. White2, K.K. Orroth2, R. Bakker3, A. Buve4,
J.D.F. Habbema3, M.C. Boily5, R.G. Hayes2, J.R. Glynn2. 'London School of
Hygiene and Tropical Medicine / Harvard Medical School, Boston, United
States, 2London School of Hygiene and Tropical Medicine, Infectious Disease
Epidemiology Unit, London, United Kingdom, 3Erasmus MC, University Medical
Center Rotterdam, Rotterdam, Netherlands, 4Institute of Tropical Medicine,
STD/HIV Research and Intervention Unit, Antwerp, Belgium, sImperial
College, London, United Kingdom
Background: HSV-2 may play an important role in HIV transmission in subSaharan Africa. This project explores the effect of a potential prophylactic HSV2 vaccine on the HIV epidemic in model simulations.
Methods: Epidemiological, behavioural, and demographic data from a crosssectional population based study in four cities (Cotonou, Benin; Yaounde,
Cameroon; Kisumu, Kenya; and Ndola, Zambia) were used to inform model
parameters. An individual-based stochastic microsimulation model simulated
the HSV-2 and HIV epidemics in the four sites. A prophylactic HSV-2 vaccine
was introduced into the model in 1997; HIV incidence ten years later was
compared to default scenarios.
Results: Assuming continuous vaccination of 14y olds and an initial mass
vaccination campaign among 14-30y olds, each with 80% coverage, and 15y
average duration of immunity, simulated reductions in population-level HIV
incidence in the four cities after ten years were 18-25% for a vaccine with 80%
efficacy. This decreased to 10-16% and 6-10% for efficacies of 50% and 30%
respectively. Without the initial mass vaccination campaign, the reduction in
HIV incidence for 80% efficacy was only 8-9%, demonstrating the importance
of a mass campaign for short-term impact on HIV.
Conclusions: HSV-2 vaccines of high or moderate efficacy could have a
substantial impact on population-level HIV incidence if delivered with high
coverage. Initial mass campaigns targeting a wide age-range will greatly hasten
the impact of vaccination.
TUPEO415
Improved STI services for sex workers reduces the
community burden of STIs in Cambodia

P. Sano', S. Sopheap', L. Sun', M. Vun', K. Fylkesnes2, P. Godwin3,
V. de Wit4, N. O'Farrell5. 'NCHADS, Phnom Penh, Cambodia, 2University of
Bergen, Bergen, Norway, 3Asian Development Bank, Phnom Penh, Cambodia,
4Asian Development Bank, Manila, Philippines, sEaling Hospital and London
School of Hygiene & Tropical Medicine, Pasteur Suite, London, United Kingdom
Background: Cambodia has designated STI clinics for direct (brothel-based)
female sex workers (DFSWs). This study aimed to assess the impact of a
Community HIV prevention project in improving standards of STI care with a

Tuesday
15 August
Poste"
txhibition

XVI INTERNATIONAL AIDS CONFERENCE * 13-18 AUGUST 2006 * TORONTO CANADA * ABSTRACT BOOK VOLUME 1