Why are we interested in IVP?

1. Intravaginal practices in a cohort of women at high risk in North-West Tanzania:Baseline associations with HIV Suzanna Francis, Tony Ao, Joseph Chilongani, Bahati Andrew, Deborah Watson-Jones, Saidi Kapiga, Richard Hayes Funded by the UK British Medical Research Council (MRC) and the European and Developing Countries Clinical Trials Partnership (EDCTP)

2. Why are we interested in IVP? • Intravaginal practices (IVP): cleansing and insertion • IVP are highly prevalent among women in many parts of sub-Saharan Africa • Meta-analysis concluding that some types of IVP are a risk factor for HIV infection • IVP may affect the impact of female controlled HIV prevention methods, such as vaginal microbicides

3. Background • Observational cohort of women at high risk for HIV in three urban settlements close to mines in North- West Tanzania • Objectives: • To describe and quantify reported IVP • To investigate associations between IVP and HIV at the screening visit

4. Methods • Screening visits: Aug 2008 to Aug 2009 • Study population: Women at high risk • Food vendors • Restaurant / grocery workers • Bar, disco, local brew sellers • Guesthouse / hotel workers • N = 1,800 • Screening visit had a face to face questionnaire and HIV testing

5. Results • Overall HIV Prevalence 21% • HIV Prevalence by occupation • Food vendors 11% • Restaurant / grocery workers 17% • Bar, disco, local brew sellers 33% • Guesthouse / hotel workers 39%

6. Description of reported IVP in the past 3 months

7. Description of reported IVP in the past 3 months

8. Description of reported IVP in the past 3 months

9. Description of reported IVP in the past 3 months

10. Description of reported IVP in the past 3 months

11. Unadjusted associations between IVP and HIV

12. Unadjusted associations between IVP and HIV p-trend = 0.002

13. Unadjusted associations between IVP and HIV

14. Adjusted associations between IVP and HIV * Age group, employment, and number of sex partners in the last three months as these were independently associated with prevalent HIV 14

15. Adjusted associations between IVP and HIV * Age group, employment, and number of sex partners in the last three months. Adjusted p-trend = 0.006 15

16. Most common type of IVP is cleansing with soap and fingers Evidence of an association between cleansing and prevalent HIV Strong evidence of a dose-response with frequency of cleansing and prevalent HIV Some evidence of an association between insertion and prevalent HIV Summary

17. Limitations • Baseline, cross-sectional analysis • Small numbers reporting some types of IVP • Possible reporting bias • Limited variables to assess confounding as there was no other STI testing or physical examination

18. Future work • Incidence analysis combining data from Tanzanian sites and our sister site in Kampala, Uganda • Diary study in both Tanzania and Uganda describing the patterns of IVP behavior in more detail

19. Acknowledgements • The participants in the study • Study teams and team leaders in Geita, Shinyanga, and Kahama • Data team lead by Clemens Masesa • Laboratory staff lead by Aura Andreasen and John Changalucha