Evidence of declining STD prevalence in a South African mining community following a core-group intervention

Objectives: To reduce the prevalence of curable sexually transmitted diseas es (STDs) in a South African mining community through provision of STD trea tment services, including periodic presumptive treatment and prevention edu cation to a core group of high-risk women living in areas around the mines. Methods: Women at high risk for STDs attended a mobile clinic monthly for e xamination and counseling, and were treated presumptively for bacterial STD s with a directly observed l-g dose of azithromycin, Gonococcal and chlamyd ial infection rates were measured by urine ligase chain reaction, and genit al ulcers were assessed by clinical examination. Changes in STD prevalence among local miners were assessed through comparison of prevalence in two cr oss-sectional samples of miners taken 9 months apart, and through routine d isease surveillance at mine health facilities. Results: During the first 9 months of the intervention, 407 women used the services. Baseline prevalence of Neisseria gonorrhoeae and/or Chlamydia tra chomatis in women was 24.9%; 9.7% of these women had clinical evidence of g enital ulcer disease (GUD). The proportion of women with incident gonococca l or chlamydial infections at the first monthly return visit (69% follow-up rate) was 12.3%, and genital ulcers were found in 4.4% of these women. In the miner population, the prevalence of Neisseria gonorrhoeae and/or C trac homatis was 10.9% at baseline and 6.2% at the 9-month follow-up examination (P < 0.001), The prevalence of GUD by clinical examination was 5.8% at bas eline and 1.3% at follow-up examination (P < 0.001). Rates of symptomatic S TDs seen at mine health facilities decreased among miners in the interventi on area compared with miners living farther from the site and with less exp osure to the project.