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Control de las enfermedades de transmisión sexual para la prevención del SIDA en Uganda: un ensayo comunitario
M J Wawer1, N K Sewankambo, D Serwadda
1Centre for Population and Family Health, Columbia University School of Public Health, New York 10032, USA.
Lancet (London, England)
|February 24, 1999
Resumen
El control de las enfermedades de transmisión sexual (ETS) a nivel comunitario no redujo la incidencia del VIH-1 en Uganda. La mayoría de las infecciones por VIH-1 ocurrieron independientemente de las ETS tratables, lo que sugiere que otras rutas de transmisión requieren atención.
Área de la Ciencia:
- Salud Pública La salud pública.
- Enfermedades infecciosas Enfermedades infecciosas.
- Epidemiología La epidemiología.
Sus antecedentes:
- Las enfermedades de transmisión sexual (ETS) son cofactores conocidos en la transmisión del VIH-1.
- Las intervenciones a nivel comunitario tienen como objetivo reducir la prevalencia de ETS y, posteriormente, reducir la incidencia del VIH-1.
Objetivo del estudio:
- Para probar si el control intensivo de ETS a nivel comunitario reduce la incidencia del VIH-1.
- Evaluar el impacto del tratamiento antibiótico masivo en las tasas de ETS y VIH-1 en el distrito de Rakai, Uganda.
Principales métodos:
- Un ensayo aleatorizado, controlado y basado en la comunidad que involucra a 10 grupos en el distrito de Rakai, Uganda.
- Los participantes de entre 15 y 59 años recibieron un tratamiento antibiótico masivo en el hogar (intervención) o vitaminas/antelmínticos (control).
- Datos recopilados a través de entrevistas y muestras biológicas para la evaluación de ETS y VIH-1; se utilizaron análisis de intención de tratar.
Principales resultados:
- La intervención redujo significativamente la prevalencia de la sífilis y la tricomoniasis.
- No se observó ninguna diferencia significativa en la incidencia del VIH-1 entre los grupos de intervención y de control (1,5 por cada 100 años-persona en ambos).
- No se encontró ningún efecto sobre la incidencia del VIH-1 en mujeres embarazadas o en análisis estratificados.
Conclusiones:
- El control intensivo de las ETS a través del tratamiento antibiótico masivo no redujo la incidencia del VIH-1 en esta población.
- Una porción significativa de la adquisición del VIH-1 parece ser independiente de los cofactores de ETS tratables.
- Se necesita más investigación para comprender las rutas de transmisión que no están vinculadas a las ETS tratables.
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