American Journal of Epidemiology Advance Access first published online on April 3, 2008
This version published online on April 9, 2008
American Journal of Epidemiology, doi:10.1093/aje/kwn066
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Original Contribution |
Geographic Prevalence and Multilevel Determination of Community-level Factors Associated with Herpes Simplex Virus Type 2 Infection in Chennai, India
1 Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD
2 Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
3 Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
4 Y. R. Gaitonde Center for AIDS Research and Education (Y.R.G. CARE), Chennai, India
5 Division of Infectious Diseases, School of Medicine, Brown University, Providence, RI
6 The Miriam Hospital, Providence, RI
7 Family Health International, Dhaka, Bangladesh
Correspondence to Dr. Jacky Jennings, Department of Pediatrics, Johns Hopkins School of Medicine, Bayview Medical Center, 5200 Eastern Avenue, Mason F. Lord Building–Center Towers, Room 407, Baltimore, MD 21224 (e-mail: jjennin1{at}jhmi.edu).
Received for publication April 17, 2007. Accepted for publication February 28, 2008.
Herpes simplex virus type 2 (HSV-2) is one of the most prevalent sexually transmitted infections, and it increases the risk of transmission of human immunodeficiency virus type 1 at least twofold. Individual-level factors are insufficient to explain geographic and population variation in HSV-2, suggesting the need to identify ecologic factors. The authors sought to determine the geographic prevalence and community-level factors associated with HSV-2 after controlling for individual-level factors among slums in Chennai, India. From March to June 2001, participants aged 18–40 years voluntarily completed a survey and were tested for HSV-2. Community characteristics were assessed through interviews with key informants and other secondary data sources. Multilevel nonlinear analysis was conducted. Eighty-five percent of eligible persons completed the survey; of these, 98% underwent HSV-2 testing, producing a final sample of 1,275. Participants were of Tamil ethnicity, were predominantly female and married, and were on average 30 years old. Fifteen percent were infected with HSV-2, and there was significant variation in HSV-2 prevalence among communities. After controlling for individual-level factors, the authors identified community-level factors, including socioeconomic status and the presence of injection drug users, that were independently associated with HSV-2 and explained 11% of the variance in prevalence. Future studies are needed to test mechanisms through which these community-level factors may be operating.
disease transmission; herpesvirus 2, human; residence characteristics; risk factors; sexually transmitted diseases, viral; simplexvirus
Abbreviations: HIV-1, human immunodeficiency virus type 1; HSV-2, herpes simplex virus type 2; SD, standard deviation; SES, socioeconomic status; STI, sexually transmitted infection
"This version corrects T.L. Louis to T. A. Louis"