GHENT UNIVERSITY Karoline FONCK - International Centre for ...

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All studies were approved by the ethical committee of the University of Nairobi. No additional ethical approval from another institution was sought, except for the randomized placebocontrolled trial. This trial was executed in collaboration with the University of Manitoba, Winnipeg, Canada, and received additional approval from the ethical committee of that University. A drug and safety monitoring board (DSMB) was established to monitor that study closely. Informed consent was obtained from all study participants. 2.2.2. Data collection a. Staff The core staff involved in the research studies consisted of two local physicians, a social scientist, a nurse, a counselor, a data entry person, one administrator, one clerical staff and one driver. Whenever necessary, extra staff was hired for temporary assignments. These persons were mainly recruited among the existing University of Nairobi staff or from the Nairobi City Council. Data collection was performed by trained staff using hospital and clinic record cards as well as standard questionnaires specifically designed for these clinical epidemiological studies. b. Quality of the data Substantial consideration was given to the method of data collection. Many of the standard interview forms also catered for behavioral and sexual data. To avoid incorrect answers on these sensitive issues, experts in communication have been involved in the preparation of the questionnaires. Before the start of the studies, the questionnaires were field tested and adapted. Research assistants were trained in the use of the questionnaires. However, no quality control for questionnaire administration was done. It can be presumed though that if systematic errors occurred, they should be similar in HIV positive and negative persons, as in almost all cases the patients were not aware of their serostatus. A copy of the study proposals, standard questionnaires and data entry forms are available upon request. OBJECTIVES AND METHODS 19
2.2.3. Laboratory procedures The microbiological and serological laboratory methods are described in detail in the different chapters. The samples were collected by the research staff and transported to the research laboratory at the Department of Medical Microbiology, University of Nairobi. Here thoroughly trained personnel performed the tests in excellent conditions and with up-to-date equipment. The laboratory was a research lab only and did not serve other hospitals or clinics. However, because of cost-recovery this has changed in the last couple of years of the study. The lab is funded by Canadian, American, European Union, Belgian and Kenyan research grants. All senior laboratory staff has been trained in overseas laboratories of the collaborating institutions. Some tests were also performed at the laboratory of the STI referral clinic in Nairobi. This lab had been considerably upgraded by the project and qualified staff had been hired. This lab performed the quality control for the peripheral health centers for instance, all positive RPR tests as well as 10% of the negative samples were retested at STC. The samples from the STI clinic were in turn controlled by the lab at the University of Nairobi. Some of the samples were also sent to the laboratories of the collaborating universities overseas, either to perform the tests that could not be done on site, or for quality control on a random selection of samples. Internal quality control was performed on a regular basis. 2.2.4. Data analysis Along with the questionnaire, a computerized database structure was created for data entry. Data was entered at the project offices either at the STI clinic or at the University of Nairobi. Several computers were available to that effect. The data entry was supervised by the respective research staff and under the overall supervision of the project manager. The data from the earliest studies were entered in Epi-info (version 6.0) and afterwards exported to SPSS for analysis. Later on, most data were entered and analyzed in SPSS for Windows version 8.0 (SPSS Inc. Chicago). For one study the data were first entered in ACCESS Microsoft and later exported into SPSS. Data were entered continuously throughout the studies. Interim analysis was performed regularly to monitor the study and discussed in meetings with the research staff. OBJECTIVES AND METHODS 20
Page 1 and 2: GHENT UNIVERSITY STI PREVENTION AND
Page 3 and 4: AIDS Acquired Immune Deficiency Syn
Page 5 and 6: 1.1. Sexually Transmitted Infection
Page 7 and 8: countries, the rate of reporting co
Page 9 and 10: district of Uganda randomized villa
Page 11 and 12: By identifying where significant
Page 13 and 14: 4.5%, 3.9%, 67.7% and 30.1% while t
Page 15 and 16: female primary health care or anten
Page 17 and 18: The research data have been publish
Page 19: 2.1. OBJECTIVES 2.1.1. General obje
Page 23 and 24: C HAPTER 3 PREVALENCE AND RISK FACT
Page 25 and 26: After registration by the clinic cl
Page 27 and 28: The majority of the women were infe
Page 29 and 30: eing single, ever having been treat
Page 31 and 32: prevalence found in a family planni
Page 33 and 34: 3.2. Declining Syphilis Prevalence
Page 35 and 36: Training Nurses at the antenatal cl
Page 37 and 38: We believe that the observed declin
Page 39 and 40: Wasserheit 1992, Laga 1993). In Nai
Page 41 and 42: Table 1: Demographic data of 471 pa
Page 43 and 44: women. Overall, significantly fewer
Page 45 and 46: Stigmatization by health staff also
Page 47 and 48: 4.2. Health-Seeking Behavior and Se
Page 49 and 50: Between September and November 1998
Page 51 and 52: Table 2: Healthcare-seeking behavio
Page 53 and 54: Thirteen women had engaged in sex w
Page 55 and 56: Men reported more extramarital affa
Page 57 and 58: C HAPTER 5 DIAGNOSIS AND MANAGEMENT
Page 59 and 60: discharge and abdominal pain-two co
Page 61 and 62: Data were entered and analyzed in S
Page 63 and 64: One of the peripheral health center
Page 65 and 66: Evaluation of Algorithms The result
Page 67 and 68: In this study of symptomatic women,
Page 69 and 70: C HAPTER 6 PREVENTION OF SEXUALLY T
Page 71 and 72:
Table 1: Syphilis Rapid Plasma Reag
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One should keep these problems in m
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The use of mailed reminders did not
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Table 1: Characteristics of women w
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studies, indicating that couples ar
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6.3. A Randomized, Placebo-controll
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esistance patterns in bystander flo
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In univariate analysis, the odds ra
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Widows, divorcees and separated wom
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They did not report much condom use
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The low prevalence of the other STD
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There is some evidence that frequen
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Table 1. Characteristics of HIV- po
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A significantly higher prevalence o
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There is now considerable evidence
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patients. The analysis revealed hig
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contributory factor may be that mal
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use in Kenya. In a supplement of Se
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with intensive behavioral change in
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C HAPTER 8 FINAL REMARKS STIs illus
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to protect themselves and be empowe
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Bell G, Ward H, Day S et al. Partne
Page 115 and 116:
Fleming D and Wasserheit J. From ep
Page 117 and 118:
Jackson DJ, Rakwar JP, Chohan B et
Page 119 and 120:
Manning B, Moodley J, Ross SM. Syph
Page 121 and 122:
Oberlander L, Elverdam B. Malaria i
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Serwadda D, Gray R, Wawer M et al.
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Van Dam J, Anastasi MC. Male Circum
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WHO Collaborating Center on HIV/AID
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S UMMARY Sexually transmitted infec
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notification. Innovative and locall
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connaissance des femmes sur la sant
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Nous avons démontré que le coût
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vonden we een hoge prevalentie van
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We hebben aangetoond dat de kost va
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