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Risk-based screening to identify reproductive tract infection among HIV-infected women desiring use of intrauterine contraceptives
  1. Nontokozo Langwenya1,2,
  2. Catherine S. Todd3,
  3. Heidi E. Jones4,
  4. Donald R. Hoover5,
  5. Nai-Chung Hu1,2,
  6. Agnes Ronan2,
  7. Landon Myer1,2
  1. 1Division of Epidemiology and Biostatistics, University of Cape Town, Cape Town, South Africa
  2. 2Centre for Infectious Diseases Epidemiology and Research, University of Cape Town, Rondebosch, Western Cape, South Africa
  3. 3Global Health, Population, and Nutrition Department, FHI 360, Durham, North Carolina, USA
  4. 4Department of Epidemiology & Biostatistics, City University of New York, New York, New York, USA
  5. 5Department of Statistics and Biostatistics, Rutgers University, New Brunswick, New Jersey, USA
  1. Correspondence to Nontokozo Langwenya, Division of Epidemiology and Biostatistics, University of Cape Town, Rondebosch 7925, South Africa; ntokozolangwenya{at}


Background Reproductive tract infections (RTIs) are a major cause of morbidity and mortality, yet RTI testing remains limited in resource-constrained settings. We assessed performance of an existing RTI risk assessment screening tool among women living with HIV (WLHIV) considering intrauterine contraceptive (IUC) use.

Methods We conducted a cross-sectional analysis among WLHIV screened for participation in an IUC trial in Cape Town, South Africa (NCT01721798). RTI testing included Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis and bacterial vaginosis. Tool scoring was based on five separately scored criteria: (1) age under 25 years, (2) cohabitation with a partner, (3) secondary education, (4) self-reported intermenstrual bleeding and (5) number of current sexual partners and condom use frequency (score 0–5). We assessed tool performance in detecting RTI at 0 vs 1–5, 0–1 vs 2–5 and 0–2 vs 3–5 score thresholds.

Results Of 303 women, 52% (n=157) reported antiretroviral therapy use and median age was 31 years. The prevalence of any RTI was 38% (gonorrhoea=7%, chlamydia=11%, trichomoniasis=12% and bacterial vaginosis=18%) and 8% of women had multiple RTIs. Overall, 4%, 27% and 69% of women had screening tool scores of 0, 1 or 2+, respectively. At a threshold of at least one scored criterion, the tool demonstrated high sensitivities (95%–97%) but low specificities (3%–4%) for detecting any RTI. Increasing the score threshold and/or inclusion of abnormal vaginal discharge marginally improved specificity.

Conclusion The prevalence of RTIs observed in this population was high, and the screening tool had no discriminatory power to detect prevalent RTIs.

  • intrauterine devices
  • sexually transmitted infections
  • human immunodeficiency virus
  • cervical screening
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  • Contributors NL managed data collection, conducted the analysis, and wrote the manuscript. CT developed the protocol and provided input on analysis and manuscript development. HJ assisted with analysis, protocol development, and manuscript preparation. DH contributed to analysis and manuscript development. N-CH contributed to the data cleaning and manuscript preparation. AR supervised data collection and study coordination. LM supervised data collection, analysis, and assisted with manuscript development. All authors commented extensively, reviewed the manuscript critically, and approved the final version.

  • Funding This study is funded by the Eunice Kennedy Shriver National Institute of Child Health and Development (5R01HD071804) and the Preventive Technologies Agreement from the United States Agency for International Development. The study sponsors played no role in study design; collection, analysis, and interpretation of data; and the writing of this report.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. Individual participant data that underlie the article results (tables and figures) are available for meta-analysis from 3-24 months following article publication.

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