High Prevalence of Chlamydia and Gonorrhea and the Need for Sexually Transmitted Infection Testing Among Men Who Have Sex With Men and Transgender Women in Papua New Guinea

• Authors: Avi J Hakim, US Centers for Disease Control and Prevention; Chelsea Iwamoto, Emory University; Steven G Badman, Kirby Institute, UNSW Sydney; Barne Willie, Papua New Guinea Institute of Medical Research; Simon Pekon, Papua New Guinea National Department of Health; Herick Aeno, Papua New Guinea Institute of Medical Research; Ruthy Neo-Boli, Papua New Guinea Institute of Medical Research; Sophie Ase, Papua New Guinea Institute of Medical Research; Damian Weikum, US Centers for Disease Control and Prevention; Andrew J Vallely, Kirby Institute, UNSW Sydney; Angela Kelly-Hanku, Kirby Institute, UNSW Sydney
• Journal Title: SEXUALLY TRANSMITTED DISEASES
• Volume: Volume 48, Number 2
• Publisher: Lippincott, Williams & Wilkins | 2021-02-01, Pages 109-117
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1097/OLQ.0000000000001300
• Subjects: Health Sciences, Public Health
• Keywords: Papua New Guinea; Transgender Women; Chlamydia; Gonorrhea

Abstract

Background: Papua New Guinea has among the highest prevalence of sexually transmitted infections in the world but no estimates of Chlamydia trachomatis, Neisseria gonorrhoeae, or hepatitis B virus (HBV) are available among men who have sex with men (MSM) or transgender women (TGW). Methods: We conducted respondent-driven sampling surveys among MSM and TGW in Port Moresby, Lae, and Mt Hagen (2016–2017) to characterize the prevalence of these infections. Eligibility criteria were as follows: aged ≥12 years, born male, could speak English or Tok Pisin, and had oral or anal sex with another person born male in the past 6 months. Participants were surveyed face-to-face and offered testing for anorectal and genital chlamydia and gonorrhea, syphilis, HIV, and HBV. All results are respondent-driven sampling weighted. Results: We enrolled 400 participants in Port Moresby, 352 in Lae, and 111 in Mt Hagen. Chlamydia prevalence rates in the 3 cities regardless of anatomical site were 19.9%, 19.2%, and 24.3%, respectively. Gonorrhea prevalence rates regardless of anatomical site were 10.3%, 9.4%, and 9.6%, respectively. Hepatitis B virus prevalence rates were 11.7%, 13.8%, and 13.6%, respectively. In multivariable analysis, syphilis was associated with having either chlamydia or gonorrhea in Port Moresby (adjusted odds ratio, 4.0; 95% confidence interval, 2.0–7.9) and Lae (adjusted odds ratio, 2.4; 95% confidence interval, 1.2–5.0). Conclusions: There is a large unmet need among MSM and TGW in Papua New Guinea for chlamydia and gonorrhea detection and treatment. The high prevalence of HBV reinforces the importance of ensuring introduction and scale-up of HBV treatment and immunization. Urgent efforts are needed to introduce laboratory-based diagnosis for chlamydia and gonorrhea to ensure these populations have access to much needed treatment services.