Understanding STI and HIV prevention adherence among Kenyan women

了解肯尼亚妇女对性传播感染和艾滋病毒预防的遵守情况

• 批准号: 10202463
• 负责人: Jenell Stewart
• 金额: $ 18.78万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-01 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10202463
• 关键词: AIDS prevention; Adherence; African; Age; Antibiotics; Area; Award; Behavior; Behavioral Sciences; Biological; Caring; Chlamydia; Chlamydia trachomatis; Client; Clinical; Clinical Research; Clinical Trials; Cohort Analysis; Collaborations; Communicable Diseases; Counseling; Country; Data; Dedications; Diagnosis; Doxycycline; Effectiveness; Enrollment; Epidemic; Equation; Etiology; Evaluation; Event; Female Adolescents; Focus Groups; Frequencies; Future; Gender; Gonorrhea; HIV; HIV Infections; HIV prevention trial; HIV risk; Hair; Healthcare; Incidence; Income; Individual; Infection Control; International; Interpersonal Violence; Interview; Investigation; Kenya; Mainstreaming; Measures; Mentored Patient-Oriented Research Career Development Award; Mentors; Mentorship; Methods; Monitor; Morbidity - disease rate; Mycoplasma genitalium; Neisseria gonorrhoeae; PSA screening; Parents; Pelvic Inflammatory Disease; Pharmaceutical Preparations; Physicians; Policies; Population; Pregnancy Complications; Prevention; Prevention strategy; Prophylactic treatment; Questionnaires; Reporting; Research; Research Personnel; Research Training; Resources; Risk; Risk Behaviors; Risk Reduction; STI prevention; Sampling; Scientist; Sex Behavior; Sexually Transmitted Diseases; Surveys; Syphilis; Target Populations; Tenofovir; Testing; Training; Training Programs; Treponema pallidum; Universities; Unsafe Sex; Vagina; Washington; Woman; Work; adverse pregnancy outcome; arm; base; behavioral adherence; career; career development; chronic pain; clinical epidemiology; clinical trial analysis; design; empowered; epidemiology study; experience; gender equity; improved; infection rate; longitudinal analysis; low and middle-income countries; male; men who have sex with men; mortality; multidisciplinary; novel; parent grant; pathogen; peer; point of care; pre-exposure prophylaxis; prevent; programs; randomized trial; response; secondary analysis; self reported behavior; sexual HIV transmission; sexual relationship; tubal infertility; violence exposure; young woman

ABSTRACT This K23 Mentored Patient-Oriented Research Career Development Award proposal supports a 5-year research and training program for Dr. Jenell Stewart to establish herself as an independent investigator with expertise in sexually transmitted infection (STI) and HIV prevention. Dr. Stewart is an Infectious Diseases physician-scientist with a strong track record of dedication to STI and HIV research in low-resource settings and extensive experience in international collaborations. For this proposal, Dr. Stewart will benefit from additional training, including formal course work and mentorship, in design and analysis of STI and HIV prevention trials, assessment of sexual exposures and event-driven adherence, and mixed-methods analysis of gendered power dynamics in adherence behavior. In the past decade, rates of bacterial STIs have increased markedly in populations worldwide. In addition to increased risk of HIV infections, young Kenyan women have very high STI rates with severe consequences (e.g., pelvic inflammatory disease, tubal infertility, complications of pregnancy). Post-exposure prophylaxis (PEP) with the antibiotic doxycycline (dPEP) has been proposed as a novel STI control strategy, and dPEP trials among men who have sex with men are ongoing with one completed and multiple planned. This K23 proposal will leverage the first trial of dPEP among women, launching in Kenya in January 2020. In contrast to other STI prevention strategies that rely on partner participation, on-demand dPEP would be woman-controlled; however, little is known about adherence behavior to STI prevention among Kenyan women. Understanding adherence to HIV pre-exposure prophylaxis (PrEP) in African women was key to accurately defining effectiveness in this population, and similarly dPEP adherence will be important to measure and evaluate. We hypothesize that provision of dPEP with high adherence will substantially reduce the incidence of bacterial STIs, particularly Chlamydia trachomatis as well as Treponema pallidum and Mycoplasma genitalium. The longitudinal evaluation of M. genitalium in women in the parent randomized trial of dPEP will provide unique data on this emerging STI. Aim 1 will measure the effect of dPEP adherence on bacterial STI protection by leveraging a randomized trial of dPEP versus standard risk-reduction counseling among Kenyan women (N=446) followed for 12 months using hair drug concentrations to determine adherence in a comprehensive case-cohort analysis. Aim 2 will assess the impact of a recent diagnosis with an STI from point- of-care STI testing on subsequent longitudinal prevention behavior (adherence to dPEP and PrEP and frequency of condomless sex) using self-reported behavior validated against biological measures. Aim 3 will determine how gendered power dynamics relate to adherence behavior using a mixed methods analysis of quantitative and qualitative measures of gendered power differentials in primary sexual relationships. This proposal will provide important evidence to avert morbidity and mortality from bacterial STI and HIV acquisition among women.

抽象的 这项K23指导了以患者为导向的研究职业发展奖提案，支持一项为期5年的研究 和詹妮尔·斯图尔特（Jenell Stewart）博士的培训计划，以建立自己的独立调查员 性传播感染（STI）和HIV预防。斯图尔特博士是一种传染病医师科学家 在低资源环境中对性传播感染和艾滋病毒研究的敬意记录和广泛的记录 有国际合作的经验。对于此建议，斯图尔特博士将受益于其他培训， 包括正式的课程工作和指导，在STI和HIV预防试验的设计和分析中， 评估性暴露和事件驱动的依从性，以及对性别权力的混合方法分析 依从性行为的动态。在过去的十年中，细菌性传播疾病的发生率显着提高 全球人口。除了增加艾滋病毒感染的风险外，年轻的肯尼亚妇女的STI很高 具有严重后果的速率（例如，骨盆炎症性疾病，输卵管不育症，妊娠并发症）。 已经提出了抗生素强力霉素（DPEP）的暴露后预防（PEP）作为一种新型STI 与男性发生性关系的男性中的控制策略和DPEP试验正在完成，并且 多个计划。该K23提案将利用DPEP在妇女中的首次审判，并在肯尼亚发射 2020年1月。与依靠合作伙伴参与的其他STI预防策略相比 会受到女人的控制；但是，关于肯尼亚人对STI预防的依从性行为知之甚少 女性。了解非洲妇女遵守艾滋病毒暴露前预防（PREP）是至关重要的 准确定义该人群的有效性，同样，DPEP依从性对于衡量很重要 并评估。我们假设DPEP具有很高的依从性将大大降低发病率 细菌性传播疾病，尤其是沙眼衣原体以及毛颗粒和支原体 生殖器。在DPEP的父母随机试验中，女性生殖器分枝杆菌的纵向评估将 提供有关此新兴STI的独特数据。 AIM 1将测量DPEP依从性对细菌性STI的影响 通过利用DPEP与标准风险咨询的随机试验来保护肯尼亚人 妇女（n = 446）随后使用头发药物浓度进行12个月的时间，以确定A 全面的病例分析。 AIM 2将评估来自点的STI最近诊断的影响。 对随后的纵向预防行为进行的CARE STI测试（遵守DPEP和PREP和频率 无避孕套的性别）使用根据生物学措施验证的自我报告的行为。 AIM 3将决定如何 性别动力动力学与依从性行为有关，使用定量和的混合方法分析 基本性关系中性别权力差异的定性措施。该建议将提供 妇女中避免细菌性传播感染和艾滋病毒收购的发病率和死亡率的重要证据。