STI epidemic re-emergence, socio-epidemiological clusters characterisation and HIV coinfection in Catalonia, Spain, during 2017–2019: a retrospective population-based cohort study
Alexis Sentís,
Patricia Garcia de Olalla,
A Martinez,
Jordi Casabona,
Laia Egea-Cortés,
P Ciruela,
C Rius,
P Godoy,
E Lopez,
M ROS,
V González,
I Parron,
G Carmona,
J Casabona,
S Hernandez,
M Carol,
R Mansilla,
J Reyes,
Marcos Montoro-Fernandez,
Evelin Lopez-Corbeto,
Daniel K Nomah,
Yesika Díaz,
Lilas Mercuriali,
Núria Borrell,
Juliana Reyes-Urueña,
A Sentís,
R Lugo,
MP Bonamusa,
P Garcia de Olalla,
L Mercuriali,
E Masdeu,
M Company,
M Danés,
N Camps,
RM Vileu,
G Ferrús,
N Borrell,
S Minguell,
J Ferràs,
I Mòdol,
MA Tarrès, J Pérez,
M Boldú,
I Barrabeig,
E Donate,
L Clotet,
MR Sala,
V Guadalupe-Fernández,
J Mendioroz,
JL Martínez
Affiliations
Alexis Sentís
Instituto de Salud Carlos III, Madrid, Spain
Patricia Garcia de Olalla
Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
A Martinez
2Immunology Unit, la Paz University Hospital, Madrid, Spain
Jordi Casabona
Biomedical Research Networking Centre in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
Laia Egea-Cortés
Fundació Institut d`Investigació Germans Trias i Pujol (IGTP), Badalona, Spain
P Ciruela
C Rius
P Godoy
E Lopez
M ROS
V González
I Parron
G Carmona
J Casabona
S Hernandez
M Carol
R Mansilla
J Reyes
3Investigation, Pontificia Universidad Catolica Madre y Maestra, Santiago, Dominican Republic
Marcos Montoro-Fernandez
Centre of Epidemiological Studies of Sexually Transmitted Disease and AIDS in Catalonia (CEEISCAT), Department of Health, Generalitat of Catalonia, Badalona, Spain
Evelin Lopez-Corbeto
Centre of Epidemiological Studies of Sexually Transmitted Disease and AIDS in Catalonia (CEEISCAT), Department of Health, Generalitat of Catalonia, Badalona, Spain
Daniel K Nomah
Centre of Epidemiological Studies of Sexually Transmitted Disease and AIDS in Catalonia (CEEISCAT), Department of Health, Generalitat of Catalonia, Badalona, Spain
Yesika Díaz
Fundació Institut d`Investigació Germans Trias i Pujol (IGTP), Badalona, Spain
Lilas Mercuriali
Epidemiology Service, Public Health Agency of Barcelona, Barcelona, Spain
Núria Borrell
Epidemiological Surveillance and Response to Public Health Emergencies Service in Tarragona, Agency of Public Health of Catalonia, Generalitat of Catalonia, Tarragona, Spain
Juliana Reyes-Urueña
Centre d`Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Departament de Salut, Generalitat de Catalunya, Badalona (Barcelona), Spain
Objectives To describe the epidemiology of sexually transmitted infections (STIs), identify and characterise socio-epidemiological clusters and determine factors associated with HIV coinfection.Design Retrospective population-based cohort.Setting Catalonia, Spain.Participants 42 283 confirmed syphilis, gonorrhoea, chlamydia and lymphogranuloma venereum cases, among 34 600 individuals, reported to the Catalan HIV/STI Registry in 2017–2019.Primary and secondary outcomes Descriptive analysis of confirmed STI cases and incidence rates. Factors associated with HIV coinfection were determined using logistic regression. We identified and characterized socio-epidemiological STI clusters by Basic Health Area (BHA) using K-means clustering.Results The incidence rate of STIs increased by 91.3% from 128.2 to 248.9 cases per 100 000 population between 2017 and 2019 (p<0.001), primarily driven by increase among women (132%) and individuals below 30 years old (125%). During 2017–2019, 50.1% of STIs were chlamydia and 31.6% gonorrhoea. Reinfections accounted for 10.8% of all cases and 6% of cases affected HIV-positive individuals. Factors associated with the greatest likelihood of HIV coinfection were male sex (adjusted OR (aOR) 23.69; 95% CI 16.67 to 35.13), age 30–39 years (versus <20 years, aOR 18.58; 95% CI 8.56 to 52.13), having 5–7 STI episodes (vs 1 episode, aOR 5.96; 95% CI 4.26 to 8.24) and living in urban areas (aOR 1.32; 95% CI 1.04 to 1.69). Living in the most deprived BHAs (aOR 0.60; 95% CI 0.50 to 0.72) was associated with the least likelihood of HIV coinfection. K-means clustering identified three distinct clusters, showing that young women in rural and more deprived areas were more affected by chlamydia, while men who have sex with men in urban and less deprived areas showed higher rates of STI incidence, multiple STI episodes and HIV coinfection.Conclusions We recommend socio-epidemiological identification and characterisation of STI clusters and factors associated with HIV coinfection to identify at-risk populations at a small health area level to design effective interventions.
