Clinical epidemiology of HSV-2 and the impact of interventions against sexually transmitted infections to reduce HIV incidence in high risk women from gold mining communities in Tanzania. (360G-Wellcome-066688_Z_01_B)

1.     In sub-Saharan Africa high risk women (HRW) who engage in sex for money, also known as female sex workers (FSW), and their clients are most at risk of acquiring HIV infection and sexually transmitted infections (STIs). STIs are likely to be particularly important co-factors for acquisition of HIV in HRW. Development and evaluation of new strategies to control both ulcerative and non-ulcerative STIs in order to reduce HIV incidence in high risk populations are urgently needed. The role of Herpes simplex virus type 2 (HSV-2) as a cause of genital ulceration is increasingly recognised. However, there are few current data on the aetiology of genital ulcers in this population or on the clinical epidemiology of HSV-2 or whether anti-herpetic treatment would reduce HIV incidence. This project therefore proposes to conduct 4 inter-linked studies in NW Tanzania: A study of the current aetiology of genital ulcers will be done in STI clinic attenders presenting with symptomatic genital ulceration. A placebo-controlled trial of monthly azithromycin and metronidazole and/or HSV-2 suppressive therapy with valaciclovir as a strategy to reduce HIV incidence, HSV-2 and HIV viral shedding and STI prevalence will be carried out in a cohort of HRW. The effects of these interventions on HIV incidence in discordant regular sexual partners of HIV-positive women will also be examined. The interaction between HIV and HSV-2 shedding will be examined in a sub-group of HRW.