(P368) Risk factors for curable sexually transmitted infections among youth: findings from a population survey in Zimbabwe

Background

Sexually transmitted infections (STIs) can lead to serious morbidity, and youth are an important risk group for infection. We aimed to determine the risk factors for curable STIs in youth in Zimbabwe.

Methods

A population prevalence survey was conducted of 18-24 year olds in sixteen communities in the Harare and Bulawayo provinces, Zimbabwe to ascertain outcomes for a cluster randomised trial investigating the impact of community-based STI testing for youth on population prevalence of STIs (trial registration number: ISRCTN15013425). Enrolled individuals underwent an interviewer-administered questionnaire, and provided urine for testing for chlamydia (CT), gonorrhoea (NG), and trichomoniasis (TV), using the multiplex Seegene assay. Risk factors for STIs were explored using multivariate logistic regression, using a three-level hierarchical conceptual approach (Figure 1).


Results

Of the 5601 participants, 62.5% (n = 3500) were female, and the median age was 20 (IQR 19 – 22) years. HIV prevalence was 6.3% (351/5556) and over half reported not using a condom at last intercourse. Only 7.2% (401/5599) reported STI symptoms, but the prevalence of a positive test for at least one of CT, NG, or TV, was 19.8% (1107/5601). On multivariate analysis, factors associated with having an STI included being aged 21 to 24 years (aOR 1.36, 95% CI 1.16 – 1.60); female sex (aOR 2.13, 95% CI 1.78 – 2.56); being unemployed or informally employed (compared to being in education/formal employment) (aOR 1.36, 95% CI 1.14 – 1.62); increasing numbers of sexual partners; having a positive HIV test (aOR 1.46, 95% CI 1.08 – 1.96); and history of attempted suicide (aOR 1.57, 95% CI 1.07 – 2.31). Protective factors included increased education levels and male circumcision (aOR 0.63, 95% CI 1.07 – 2.31).


Conclusion

The prevalence of STIs among youth in Zimbabwe is high, particularly among those living with HIV. In addition to an urgent need for moving away from syndromic STI management and strengthening implementation of prevention tools already at our disposal, a more holistic focus to address broader risk factors such as mental health and employment opportunities for young people, alongside integration of HIV and STI programming, is needed for STI control.