Vaginosis, Bacterial Clinical Trial
Official title:
Vaginal Practices in Human Immunodeficiency Virus (HIV) Positive Women in Zambia, a Bio-Behavioral Intervention "WASH-2"
Intravaginal practices (IVP) (cleansing or introducing products inside the vagina for hygiene, health or to please sexual partners) are common among women with HIV. IVP increase the risk of developing bacterial Vaginosis (BV), the most common genital infection associated with transmission of sexually transmitted infections and HIV. This study tested a pilot intervention to reduce IVP and BV in HIV infected women in Zambia. A total of 128 HIV infected women engaging in IVP were randomized to two conditions: enhanced standard of care (n = 70) and experimental (n = 58). All participants received a brief educational counseling session on discontinuation of IVP, and those with BV, were provided with medical treatment for BV. Women in the experimental condition received an additional group-based, culturally tailored intervention. Participants completed questionnaires assessing sexual risk factors and IVP and were assessed for BV using Nugent criteria at baseline, 6 months and 12 months.
Zambia has high rates of women of childbearing age infected with Human Immune Deficiency
Virus (HIV). The majority (93%) engage in intravaginal practices (here referred to as IVP)
by internal cleansing (intravaginal cleansing) or by inserting products inside the vagina
(intravaginal insertion). IVP are culturally driven practices associated with an increased
risk of HIV transmission and may play an important role in exacerbating the HIV epidemic
across sub-Saharan Africa.
This application proposes to 1) evaluate the long term impact of a bio-behavioral
intervention targeting VP among HIV infected women (n=128) in Lusaka, Zambia, and 2) assess
the relative contributions of VP and bacterial vaginosis (BV) to lower genital tract
inflammation and HIV shedding. Study aims will address the following:
Aim 1. To develop and evaluate the long term impact of a culturally tailored bio-behavioral
intervention aimed to decrease IVP in HIV positive women and evaluate the relative
contribution of IVP and BV to lower genital inflammation and shedding of HIV.
Aim 1.1. To develop and evaluate the long term impact of a bio-behavioral intervention to
decrease IVP.
Intra vaginal practices, as culturally driven and condoned behaviors, are difficult to
modify. It is hypothesized that a culturally tailored bio-behavioral intervention is needed
to decrease IVP, and that women participating in the intervention condition will reduce IVP
in comparison with women in a time matched control condition. Experimental approach: Women
engaging in IVP will be randomly assigned to one of two conditions (intervention or
control). IVP will be evaluated and compared over 12 months.
Aim 1.2. To compare rates of BV, lower genital tract inflammatory markers and HIV shedding
in HIV infected women engaging in VP with and without BV.
Due to the close relationship between IVP and BV, it is difficult to determine the relative
contribution of each to lower genital tract inflammation and HIV shedding. It is
hypothesized that women engaging in IVP with BV will have similar levels of both lower
genital tract inflammatory cytokines and HIV viral load to those without BV. Experimental
approach: Vaginal secretions and cervicovaginal fluid will be collected from women engaging
in IVP. The presence of BV, inflammatory cytokines (IL-6 and IL-8), and HIV RNA will be
determined by gram stain, ELISA and PCR techniques respectively, and compared in women that
engage in IVP with and without BV.
Aim 1.3. To compare BV, lower genital inflammatory markers and shedding of HIV in HIV
seropositive women participating in the intervention versus control condition.
Interventions to decrease IVP have the goal of reducing BV and associated adverse health
outcomes. It is hypothesized that the bio-behavioral intervention will decrease BV, lower
genital tract inflammation and HIV shedding. Experimental approach: Laboratory assessments
used for Aim 1.2 will be repeated and compared at baseline, 6 and 12 months.
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