Table. 2.
Characteristics of included studies (n=32) and effect sizes (k=97) assessing the effect of nonviral STI on the risk of HIV seroconversion among high-risk heterosexuals
| Total Studies (n=32) | Total Effect Sizes (k=97*) | |||
|---|---|---|---|---|
| Characteristics of Included Studies | n | % | k | % |
| Study Design | ||||
| Prospective cohort | 27 | 84.4% | 78 | 80.4% |
| Retrospective cohort | 2 | 6.3% | 7 | 7.2% |
| Case control | 1 | 3.1% | 3 | 3.1% |
| Nested case control | 2 | 6.3% | 9 | 9.3% |
| Data Collection Start Year | ||||
| 1985–1994 | 15 | 46.9% | 39 | 40.2% |
| 1995–2004 | 8 | 25.0% | 28 | 28.9% |
| 2004–2008 | 9 | 28.1% | 30 | 30.9% |
| Publication Year | ||||
| 1991–2000 | 9 | 28.1% | 23 | 23.7% |
| 2001–2010 | 10 | 31.3% | 29 | 29.9% |
| 2011–2017 | 13 | 40.6% | 45 | 46.4% |
| Geographical Distribution | ||||
| OECD Countries | ||||
| United States | 5 | 15.6% | 13 | 13.4% |
| Non-OECD Countries | ||||
| Kenya | 8 | 25.0% | 22 | 22.7% |
| South Africa | 3 | 9.4% | 9 | 9.3% |
| Tanzania | 3 | 9.4% | 11 | 11.3% |
| Uganda | 3 | 9.4% | 12 | 12.4% |
| Other | 10 | 31.3% | 30 | 30.9% |
| Sex | ||||
| Females only | 21 | 65.6% | 78† | 80.4% |
| Males only | 3 | 9.4% | 7† | 7.2% |
| Mixed-sex group | 8 | 25.0% | 12 | 12.4% |
| Risk Group (total exceeds 100% due to overlap) | ||||
| High-risk occupation – females | 20 | 62.5% | 68 | 70.1% |
| High-risk occupation – males | 2 | 6.3% | 3 | 3.1% |
| Serodiscordant partnership – females | 4 | 12.5% | 8 | 8.2% |
| Serodiscordant partnership – males | 4 | 12.5% | 7 | 7.2% |
| STI clinic patients – females | 5 | 15.6% | 14 | 14.4% |
| STI clinic patients – males | 5 | 15.6% | 9 | 9.3% |
| Mixed risk none – females | 3 | 9.4% | 11 | 11.3% |
| Mixed risk none – males | 2 | 6.3% | 5 | 5.2% |
| People who inject drugs (PWID) | ||||
| PWID not reported | 23 | 71.9% | 70 | 72.2 |
| Reported 0% PWID | 4 | 12.5% | 9 | 9.3% |
| Reported >0% <10% PWID | 4 | 12.5% | 15 | 15.5% |
| Reported >10% PWID | 1 | 3.1% | 3 | 3.1% |
| Reporting of Intervention Coverage | ||||
| Condom use (coverage range 0–100%, median 46.8%) | 23 | 71.9% | 63 | 64.9% |
| STI Treatment (completion NR) | 25 | 78.1% | 73 | 75.3% |
| Male population circumcised (coverage range 8.0–87.0%) | 6 | 18.8% | 23 | 23.7% |
| HIV-uninfected population on PrEP | 0 | 0% | 0 | 0% |
| Total Effect Sizes (k=97 * ) | ||||
| Characteristics of Included Effect Sizes | k | % | ||
|
| ||||
| Pathogen | ||||
| Syphilis | 34 | 35.1% | ||
| Trichomonas | 21 | 21.6% | ||
| Gonorrhea | 21 | 21.6% | ||
| Chlamydia | 18 | 18.6% | ||
| Mycoplasma genitalium | 3 | 3.1% | ||
| Effect Size Type | Multivariate-Adjusted | Unadjusted | Multivariate-Adjusted | Unadjusted |
|
| ||||
| Hazard ratio | 34 | 20 | 35.1% | 20.6% |
| Odds ratio | 11 | 7 | 11.3% | 7.2% |
| Risk ratio | 4 | 12 | 4.1% | 12.4% |
| Percentage | 0 | 4 | 0.0% | 4.1% |
| Incidence rate ratio | 4 | 0 | 4.1% | 0.0% |
| Incidence rate | 0 | 1 | 0.0% | 1.0% |
| Timing of STI Assessment | ||||
| Baseline only | 42 | 43.3% | ||
| Incident STI only | 14 | 14.4% | ||
| Baseline or incident, or not reported | 41 | 42.3% | ||
| STI Diagnostic Method | ||||
| Culture or stain | 40 | 41.2% | ||
| Serology for syphilis | 34 | 35.1% | ||
| Nucleic acid amplification test (NAAT) | 23 | 23.7% | ||
| Anatomical Site | ||||
| Vaginal | 55 | 56.7% | ||
| Ureteral | 1 | 1.0% | ||
| Unspecified (includes diagnosis via serology) | 41 | 42.3% | ||
| HIV Diagnostic Procedure - Baseline | ||||
| RNA Test | 4 | 4.1% | ||
| Polymerase chain reaction | 10 | 10.3% | ||
| Western Blot (WB) or p24 test | 2 | 2.1% | ||
| 4th-Generation ELISA using venous blood | 6 | 6.2% | ||
| 3rd-Generation ELISA | 28 | 28.9% | ||
| 2nd-Generation ELISA | 2 | 2.1% | ||
| Unspecified or Mixed ELISA | 45 | 46.4% | ||
| HIV Diagnostic Procedure -Outcome | ||||
| RNA Test | 4 | 4.1% | ||
| Polymerase chain reaction | 4 | 4.1% | ||
| 4th-Generation ELISA using venous blood | 6 | 6.2% | ||
| 3rd-Generation ELISA | 31 | 32.0% | ||
| Any ELISA + WB to Confirm Positives | 35 | 36.1% | ||
| Unspecified or Mixed ELISA | 17 | 17.5% | ||
| Follow-Up Intervals (Months) | ||||
| 1 | 12 | 12.4% | ||
| 3 | 27 | 27.8% | ||
| 4 to 4.5 | 3 | 3.1% | ||
| 6 | 22 | 22.7% | ||
| 12 | 3 | 3.1% | ||
| NR | 30 | 30.9% | ||
*
73 effect sizes were included in meta-analysis
†
Sex-specific effect sizes were drawn from both studies with mixed-sex and single-sex populations.
Legend: ELISA=Enzyme-linked immunosorbent assay; IRR=Incidence rate ratio; NAAT=Nucleic acid amplification test; NR=Not reported; OECD=Organisation for Economic Co-operation and Development; PrEP= Pre-exposure prophylaxis; PWID=People who inject drugs; RNA = Ribonucleic acid; STI=Sexually transmitted infection; WB = Western Blot