Distribution of Trichomonas vaginalis Among Women at High Risk for HIV Infection

1. Distribution of Trichomonas vaginalis Among Women at High Risk for HIV Infection Barbara Van Der Pol, James Williams, Jacquelyn Murphy and the Project SHIELD Collaborators

2. Epidemiology of Trichomonas Infection • Over 170 million infections in women annually (WHO, 1996) • Not reportable in the US • Infections occur in older women • Zhang, et al, STD 23:415, 1996 • Dragsted, et al, STD 28:326, 2001

3. Significance of Trichomonas Infection • Implications of infection • adverse pregnancy outcomes • PID & infertility • Implications in spread of HIV • Increased acquisition • Increased viral shedding • Role in Cervical Cancer?

4. Description of Project Shield • Funded by Center for Mental Health Services • Evaluation of an intervention aimed at reducing HIV high-risk behaviors • Longitudinal study - 0, 3 and 6 months • 7 study sites are located in Florida, Georgia, Massachusetts, Rhode Island (2), Texas and Virginia

5. Project Shield, Target Populations • Adolescents - male & female (15-21) • have had unprotected sex within 90 days • Women at high-risk (18-65) • have had unprotected sex within 90 days • at least one additional risk-factor

6. Alternative High Schools Homeless shelters Traveler’s Aid Society facilities Crack houses HUD housing units Outpatient Detox Centers Recruitment Venues • Adolescent medicine clinics • Community-based health centers • STD Clinics • Planned Parenthood clinics • Jobs Corps training facilities

7. Laboratory Methods • Urine samples were chosen for non-invasive sampling • Amplified DNA testing was performed to detect Chlamydia, Gonorrhea and Trichomonas infections • Laboratory observations are reported here

8. Sensitivity of PCR for Detection of Trichomonas • Compared to Wet Prep microscopy • 96% more infections identified • Compared to culture • 48% more infections identified

9. Prevalence of Trichomonas by State

10. Population Description • Data from 1923 women at baseline • 784 in POP1 • ages range from 15-22, median 19 • 1126 in POP2, • range 15-58, median 36 • 13 lacked age data

11. TV Prevalence at Baseline

12. Preliminary Analysis • Age was not a predictor of trichomonas infection in POP1 (p>.16) • Age was a predictor of trichomonas infection in POP2 (p<.001) • In POP2, when controlling for race and other STI, age appears to remain an independent predictor of trichomonas infection (p<.001)

13. Age Distribution of STI GC p>.6 CT & TV p<.001 Age

14. Summary • Older women are at increased risk for trichomonas infection • Trichomonas is a useful bio-marker of STI-related risk behaviors • Trichomonas is highly prevalent in populations at risk for HIV infection

15. Program/Policy Implications • Trichomonas testing by highly sensitive methods should be included in routine STD screening programs that test for CT & GC • Knowledge of the trichomonas distribution in populations at high risk for HIV may be useful in designing HIV control efforts

16. Future Work • Additional analyses of baseline data • Analysis of incident infection data • Analysis of infection in males • Additional epidemiological studies of trichomonas infection

17. Larry Brown Rhode Island Hospital Ralph DiClemente Emory University M. Isabel Fernandez University of Miami Timothy Flanigan The Miriam Hospital Deborah Haller Virginia Commonwealth University Lori Leonard Johns Hopkins University Lydia O’Donnell Education Development Center, Inc William Schlenger Research Triangle Institute Barbara J Silver Center for Mental Health Services Collaborators