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326182
“The Cango Lyec Project – Healing the Elephant”: The impact of syphilis on HIV vulnerability among populations aged 14-49 in post-conflict Northern Uganda


Tuesday, November 3, 2015

Alden Blair, PhD. Candidate, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
Martin T Schechter, OBC MD PhD FRSC FCAHS, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
Martin Ogwang, M.D., Lacor Hospital, Gulu, Uganda
Alex Oneka, Northern Uganda Program on Health Sciences, Uganda
Nelson Sewankambo, PhD, MD, College of Health Sciences, Makerere University, Kampala, Uganda
Patrick Odong, M.D., District Health Officer, Amuru, Uganda
Sheetal Patel, PhD., Ottawa Hospital Research Institute, Ottawa, ON, Canada
Achilles Katamba, PhD., School of Medicine, Makerere University, Kampala, Uganda
Herbert Muyinda, PhD, Child Health and Development Center, University of Makerere College of Health Sciences, Kampala, Uganda
Margo Pearce, PhD; MSc; MPP; BA, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
Sam Malambas, PhD, Uganda Virus Research Institute, Entebbe, Uganda
Patricia M Spittal, PhD., School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
Background: The civil war in Northern Uganda resulted in the destruction of much of the infrastructure in the region and the displacement of almost 90% of the population. In its aftermath , conditions are rife for the spread of HIV and other STIs and yet epidemiological data remains scarce. This study affords a unique opportunity to assess levels and the relationship of STIs in the region. 

Methods: “The Cango Lyec Project” is a prospective cohort of conflict-affected populations in three districts of Northern Uganda. Participants consent to sociodemographic surveys, mental health screening tools (HTQ, HSCL), and provide blood samples for testing. Syphilis serology (RPR with TPHA conformation) occurs at each visit, and seropositive participants were treated. Gender stratified logistic regressions examined the relationship between syphilis and HIV infection and vulnerability. Multivariate models included women only due to sample size. 

Results: Of all participants, 80% of men (n=792) and 83.2% of women (n=1163) were sexually active and included for analysis, with overall syphilis rates of 3.91% and 4.82% respectively. The highest prevalence was 10.99% in one rural community. Syphilis was significantly associated with HIV in men (Odds Ratio [OR]: 2.97; 95%Confidence Interval [CI]: 1.15-6.82) and women (OR: 2.88; 1.60-5.04). Among women, syphilis was also associated with abduction (OR: 2.04; 1.16-3.51), depression (OR: 1.80; 1.00-3.16), being 30+ years of age (OR: 1.99; 1.16-3.46), more lifetime sexual partners (OR: 1.84; 1.07-3.18), and after adjustment included: HIV infection (AOR: 2.75; 1.53-4.83) and a history of abduction (OR: 1.92; 1.09-3.33).

Discussion: Women in post-conflict Northern Uganda are disproportionately impacted by both HIV infection and syphilis. Culturally-sensitive and trauma informed HIV and STI care is urgently needed in this population.

 

 

Learning Areas:

Protection of the public in relation to communicable diseases including prevention or control
Public health or related laws, regulations, standards, or guidelines
Public health or related public policy

Learning Objectives:
Discuss the intersection of the higher than previously reported rates of syphilis and HIV in post-conflict Northern Uganda and its impact of treatment and prevention programs.

Keyword(s): HIV/AIDS, STDs/STI

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a co-investigator for the study from which data is being presented. It comprises part of my PhD Dissertation research at the UBC:SPPH, one of the host institutions for the study. I have directly overseen data collection, cleaning, analysis, and the writeup of study findings.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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