{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T14:14:08Z","timestamp":1785420848592,"version":"3.56.0"},"reference-count":29,"publisher":"AOSIS","issue":"1","license":[{"start":{"date-parts":[[2025,7,10]],"date-time":"2025-07-10T00:00:00Z","timestamp":1752105600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Background: Pre-exposure prophylaxis (PrEP) for human immunodeficiency virus (HIV) was introduced in Zambia to prevent transmission, but it does not protect against sexually transmitted infections (STIs) such as syphilis. Globally, STIs have risen alongside PrEP rollout, posing significant public health concerns that require urgent attention and targeted intervention strategies.\n\nAim: We examined trends in syphilis incidence and assessed its association with PrEP use, given the increasing global burden of STIs, including among PrEP users between 2021 and 2023.\n\nSetting: Among individuals in Zambia.\n\nMethods: A retrospective database analysis of secondary data was conducted using District Health Information Software 2 (DHIS2), the Ministry of Health\u2019s primary data system. Microsoft\u00ae Excel and Stata were used for descriptive statistics and regression analysis to examine potential associations.\n\nResults: From 2021 to 2023, syphilis cases (199 273) and PrEP initiation (436 460) increased annually. Syphilis cases rose from 22% to 46%, while PrEP initiation grew from 22% to 48%. We found a positive association between syphilis incidence and PrEP initiation, with each unit increase in PrEP initiation corresponding to a 0.33-unit rise in syphilis cases (p &lt; 0.001; 95% confidence interval [CI]: 0.25\u20130.4), underscoring this relationship.\n\nConclusion: This analysis found a significant positive link between syphilis incidence and PrEP initiation, emphasising the need for integrated HIV and STI management to enhance public health interventions.\n\nContribution: This study provides valuable insights for policy and programme implications; it highlights the importance of integrating STI prevention into HIV prevention service delivery; an integrated approach is critical to ensure that the country does not regress the achievements made towards HIV epidemic control.<\/jats:p>","DOI":"10.4102\/jphia.v16i1.1306","type":"journal-article","created":{"date-parts":[[2025,7,8]],"date-time":"2025-07-08T04:15:59Z","timestamp":1751948159000},"update-policy":"https:\/\/doi.org\/10.4102\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Integrated HIV and STIs response: Trends in syphilis incidence and uptake of oral pre-exposure prophylaxis in Zambia"],"prefix":"10.4102","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8061-1332","authenticated-orcid":false,"given":"Kutha","family":"Banda","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-6579-0883","authenticated-orcid":false,"given":"Nicholus","family":"Sande","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/044d6xz07","id-type":"ROR","asserted-by":"publisher"}],"name":"National HIV\/AIDS\/STI\/TB Council"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3666-0409","authenticated-orcid":false,"given":"Chipwaila","family":"Chunga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-5677-1916","authenticated-orcid":false,"given":"Belia","family":"Longwe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-4874-0151","authenticated-orcid":false,"given":"Kayawe","family":"Nkumbwa","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/044d6xz07","id-type":"ROR","asserted-by":"publisher"}],"name":"National HIV\/AIDS\/STI\/TB Council"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-3886-9804","authenticated-orcid":false,"given":"Madaliso","family":"Silondwa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-1775-5811","authenticated-orcid":false,"given":"Nsanzya","family":"Maambo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-1036-5926","authenticated-orcid":false,"given":"Japhet","family":"Michelo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-9567-3640","authenticated-orcid":false,"given":"Prudence","family":"Haimbe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-2737-4633","authenticated-orcid":false,"given":"Trevor","family":"Mwamba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-7818-9159","authenticated-orcid":false,"given":"Hilda","family":"Shakwelele","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4218-0823","authenticated-orcid":false,"given":"Sandra","family":"Chilengi-Sakala","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1521-5138","authenticated-orcid":false,"given":"Ireen","family":"Bwalya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2580","published-online":{"date-parts":[[2025,7,10]]},"reference":[{"key":"ref0","doi-asserted-by":"crossref","unstructured":"Newman L, Rowley J, Hoorn SV, et al. Global estimates of the prevalence and incidence of four curable sexually transmitted infections in 2012 based on systematic review and global reporting. PLoS One. 2015;10(12):e0143304. https:\/\/doi.org\/10.1371\/journal.pone.0143304","DOI":"10.1371\/journal.pone.0143304"},{"key":"ref1","doi-asserted-by":"crossref","unstructured":"The Lancet Child & Adolescent Health. Youth STIs: An epidemic fuelled by shame. Lancet Child Adolesc Health. 2022;6(6):353. https:\/\/doi.org\/10.1016\/S2352-4642(22)00128-6","DOI":"10.1016\/S2352-4642(22)00128-6"},{"key":"ref2","doi-asserted-by":"crossref","unstructured":"Yu W, You X, Luo W. Global, regional, and national burden of syphilis, 1990\u20132021 and predictions by Bayesian age-period-cohort analysis: A systematic analysis for the global burden of disease study 2021. Front Med. 2024;11:1448841. https:\/\/doi.org\/10.3389\/fmed.2024.1448841","DOI":"10.3389\/fmed.2024.1448841"},{"key":"ref3","doi-asserted-by":"crossref","unstructured":"Smolak A, Rowley J, Nagelkerke N, et al. Trends and predictors of syphilis prevalence in the general population: Global pooled analyses of 1103 prevalence measures including 136 million syphilis tests. Clin Infect Dis. 2018;66(8):1184\u20131191. https:\/\/doi.org\/10.1093\/cid\/cix975","DOI":"10.1093\/cid\/cix975"},{"key":"ref4","doi-asserted-by":"crossref","unstructured":"Ahmed HJ, Omar K, Adan SY, Guled AM, Grillner L, Bygdeman S. Syphilis and human immunodeficiency virus seroconversion during a 6-month follow-up of female prostitutes in Mogadishu, Somalia. Int J STD AIDS. 1991;2(2):119\u2013123. https:\/\/doi.org\/10.1093\/cid\/cix975","DOI":"10.1177\/095646249100200209"},{"key":"ref5","doi-asserted-by":"crossref","unstructured":"Wu S, Wang J, Guo Q, et al. Prevalence of human immunodeficiency virus, syphilis, and hepatitis B and C virus infections in pregnant women: A systematic review and meta-analysis. Clin Microbiol Infect. 2023;29(8):1000\u20131007. https:\/\/doi.org\/10.1016\/j.cmi.2023.03.002","DOI":"10.1016\/j.cmi.2023.03.002"},{"key":"ref6","doi-asserted-by":"crossref","unstructured":"Ong JJ, Baggaley RC, Wi TE, et al. Global epidemiologic characteristics of sexually transmitted infections among individuals using preexposure prophylaxis for the prevention of HIV infection: A systematic review and meta-analysis. JAMA Netw Open. 2019;2(12):e1917134. https:\/\/doi.org\/10.1001\/jamanetworkopen.2019.17134","DOI":"10.1001\/jamanetworkopen.2019.17134"},{"key":"ref7","unstructured":"Ministry of Health, Zambia. The Zambia Population-Based HIV Impact Assessment (ZAMPHIA) [homepage on the Internet]. 2016 [cited 2025 Jan 25]. Available from: https:\/\/phia.icap.columbia.edu\/wp-content\/uploads\/2017\/11\/FINAL-ZAMPHIA-First-Report_11.30.17_CK.pdf"},{"key":"ref8","unstructured":"Zambia Statistics Agency, Ministry of Health (MOH) Zambia, and ICF. Zambia demographic and health survey 2018 [homepage on the Internet]. Lusaka; 2019. Available from: https:\/\/dhsprogram.com\/pubs\/pdf\/FR361\/FR361.pdf"},{"key":"ref9","doi-asserted-by":"crossref","unstructured":"Solomon H, Moraes AN, Williams DB, et al. Prevalence and correlates of active syphilis and HIV co-Infection among sexually active persons aged 15\u201359 years in Zambia: Results from the Zambia Population-based HIV Impact Assessment (ZAMPHIA) 2016. PLoS One. 2020;15(7):e0236501. https:\/\/doi.org\/10.1371\/journal.pone.0236501","DOI":"10.1371\/journal.pone.0236501"},{"key":"ref10","doi-asserted-by":"crossref","unstructured":"Nguyen VK, Greenwald ZR, Trottier H, et al. Incidence of sexually transmitted infections before and after preexposure prophylaxis for HIV. AIDS. 2018;32(4):523\u2013530. https:\/\/doi.org\/10.1097\/QAD.0000000000001718","DOI":"10.1097\/QAD.0000000000001718"},{"key":"ref11","doi-asserted-by":"crossref","unstructured":"Claassen CW, Mumba D, Njelesani M, et al. Initial implementation of PrEP in Zambia: Health policy development and service delivery scale-up. BMJ Open. 2021;11(7):e047017.","DOI":"10.1136\/bmjopen-2020-047017"},{"key":"ref12","doi-asserted-by":"crossref","unstructured":"Stewart J, Baeten JM. HIV pre-exposure prophylaxis and sexually transmitted infections: Intersection and opportunity. Nat Rev Urol. 2022;19(1):7\u201315.","DOI":"10.1038\/s41585-021-00527-4"},{"key":"ref13","doi-asserted-by":"crossref","unstructured":"Traeger MW, Cornelisse VJ, Asselin J, et al. Association of HIV Preexposure Prophylaxis With Incidence of Sexually Transmitted Infections Among Individuals at High Risk of HIV Infection. JAMA. 2019;321(14):1380. https:\/\/doi.org\/10.1001\/jama.2019.2947","DOI":"10.1001\/jama.2019.2947"},{"key":"ref14","doi-asserted-by":"crossref","unstructured":"Hainsworth G, Engel DMC, Simon C, Rahimtoola M, Ghiron LJ. Scale-up of adolescent contraceptive services: Lessons from a 5-country comparative analysis. J Acquir Immune Defic Syndr. 2014;66(Supplement 2):S200\u2013S208. https:\/\/doi.org\/10.1097\/QAI.0000000000000180","DOI":"10.1097\/QAI.0000000000000180"},{"key":"ref15","doi-asserted-by":"crossref","unstructured":"Ferlatte O, Salway T, Samji H, et al. An application of syndemic theory to identify drivers of the syphilis epidemic among gay, bisexual, and other men who have sex with men. Sex Transm Dis. 2018;45(3):163\u2013168. https:\/\/doi.org\/10.1097\/OLQ.0000000000000713","DOI":"10.1097\/OLQ.0000000000000713"},{"key":"ref16","doi-asserted-by":"crossref","unstructured":"Volk JE, Marcus JL, Phengrasamy T, et al. No new HIV infections with increasing use of HIV preexposure prophylaxis in a clinical practice setting: Figure 1. Clin Infect Dis. 2015;61(10):1601\u20131603. https:\/\/doi.org\/10.1093\/cid\/civ778","DOI":"10.1093\/cid\/civ778"},{"key":"ref17","unstructured":"Syphilis & MSM (men who have sex with men) [homepage on the Internet]. [cited 2024 Nov 05]. Available from: https:\/\/stacks.cdc.gov\/view\/cdc\/44749"},{"key":"ref18","unstructured":"Study highlights need to strengthen sexual health services for PrEP users [homepage on the Internet]. [cited 2024 Nov 6]. Available from: https:\/\/www.who.int\/news\/item\/11-12-2019-study-highlights-the-need-to-strengthen-sexual-health-services-for-prep-users"},{"key":"ref19","unstructured":"Report on global sexually transmitted infection surveillance 2015 [homepage on the Internet]. [cited 2025 Feb 4]. Available from: https:\/\/www.who.int\/publications\/i\/item\/report-on-global-sexually-transmitted-infection-surveillance-2015"},{"key":"ref20","doi-asserted-by":"crossref","unstructured":"Steen R, Wi TE, Kamali A, Ndowa F. Control of sexually transmitted infections and prevention of HIV transmission: Mending a fractured paradigm. Bull World Health Organ. 2009;87(11):858\u2013865. https:\/\/doi.org\/10.2471\/BLT.08.059212","DOI":"10.2471\/BLT.08.059212"},{"key":"ref21","doi-asserted-by":"crossref","unstructured":"Monta\u00f1o MA, Dombrowski JC, Dasgupta S, et al. Differences in sexually transmitted infection risk comparing preexposure prophylaxis users and propensity score matched historical controls in a clinic setting. AIDS. 2019;33(11):1773. https:\/\/doi.org\/10.1097\/QAD.0000000000002281","DOI":"10.1097\/QAD.0000000000002281"},{"key":"ref22","doi-asserted-by":"crossref","unstructured":"Jenkins WD, Williams LD, Pearson WS. Sexually transmitted infection epidemiology and care in rural areas: A narrative review. Sex Transm Dis. 2021;48(12):e236. https:\/\/doi.org\/10.1097\/OLQ.0000000000001512","DOI":"10.1097\/OLQ.0000000000001512"},{"key":"ref23","doi-asserted-by":"crossref","unstructured":"Gani MS, Chowdhury AMR, Nystr\u00f6m L. Urban\u2013rural and socioeconomic variations in the knowledge of STIs and AIDS among Bangladeshi adolescents. Asia Pac J Public Health. 2014;26(2):182\u2013195. https:\/\/doi.org\/10.1177\/1010539511425083","DOI":"10.1177\/1010539511425083"},{"key":"ref24","doi-asserted-by":"crossref","unstructured":"Schumacher C, Wu L, Chandran A, et al. Sexually transmitted infection screening among gay, bisexual, and other men who have sex with men prescribed pre-exposure prophylaxis in Baltimore City, Maryland. Clin Infect Dis Off Publ Infect Dis Soc Am. 2020;71(10):2637\u20132644. https:\/\/doi.org\/10.1093\/cid\/ciz1145","DOI":"10.1093\/cid\/ciz1145"},{"key":"ref25","doi-asserted-by":"crossref","unstructured":"Von Schreeb S, Pedersen SK, Christensen H, et al. Questioning risk compensation: Pre-exposure prophylaxis (PrEP) and sexually transmitted infections among men who have sex with men, capital region of Denmark, 2019 to 2022. Eurosurveillance. 2024;29(13):2300451. https:\/\/doi.org\/10.2807\/1560-7917.ES.2024.29.13.2300451","DOI":"10.2807\/1560-7917.ES.2024.29.13.2300451"},{"key":"ref26","doi-asserted-by":"crossref","unstructured":"Gombe MM, Cakouros BE, Ncube G, et al. Key barriers and enablers associated with uptake and continuation of oral pre-exposure prophylaxis (PrEP) in the public sector in Zimbabwe: Qualitative perspectives of general population clients at high risk for HIV. PLoS One. 2020;15(1):e0227632. https:\/\/doi.org\/10.1371\/journal.pone.0227632","DOI":"10.1371\/journal.pone.0227632"},{"key":"ref27","doi-asserted-by":"crossref","unstructured":"Blumenthal J, Haubrich R. Risk compensation in PrEP: An old debate emerges yet again. Virtual Mentor. 2014;16(11):909. https:\/\/doi.org\/10.1001\/virtualmentor.2014.16.11.stas1-1411","DOI":"10.1001\/virtualmentor.2014.16.11.stas1-1411"},{"key":"ref28","unstructured":"World Health Organization. WHO implementation tool for pre-exposure prophylaxis (PrEP) of HIV infection: Module 1: Clinical [homepage on the Internet]. 2017 [cited 2025 Mar 19]. Available from: https:\/\/iris.who.int\/handle\/10665\/255889"}],"container-title":["Journal of Public Health in Africa"],"original-title":[],"deposited":{"date-parts":[[2025,7,15]],"date-time":"2025-07-15T05:33:30Z","timestamp":1752557610000},"score":1,"resource":{"primary":{"URL":"https:\/\/publichealthinafrica.org\/index.php\/jphia\/article\/view\/1306"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,10]]},"references-count":29,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1,1]]}},"URL":"https:\/\/doi.org\/10.4102\/jphia.v16i1.1306","relation":{},"ISSN":["2038-9922","2038-9930"],"issn-type":[{"value":"2038-9922","type":"print"},{"value":"2038-9930","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,10]]},"article-number":"a1306"}}