Evaluation of pre-exposure prophylaxis cascade in pregnant and breastfeeding women in Cape Town, South Africa

南非开普敦孕妇和哺乳期妇女的暴露前预防级联评估

基本信息

批准号：
10330557
负责人：
DVORA JOSEPH DAVEY
金额：
$ 14.09万
依托单位：
UNIVERSITY OF CALIFORNIA LOS ANGELES
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-09-21 至 2024-01-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10330557
关键词：
18 year old AIDS prevention Adherence Adverse event Africa Age Area Behavioral Behavioral Sciences Biological Biometry Blood Breast Feeding Client Clinic Clinical Research Clinical Trials Communities Data Doctor of Philosophy Educational Background Educational workshop Enrollment Epidemiologist Epidemiology Evaluation Faculty Female Funding Goals Grant Guidelines HIV HIV Infections HIV Seronegativity Health Health Personnel Health care facility Incidence Intervention Interview Knowledge Measures Medical Research Mentored Research Scientist Development Award Mentors Mentorship Meta-Analysis Methodology Methods Modeling Participant Patient Self-Report Persons Pharmacy facility Plasma Postnatal Care Postpartum Period Practice Guidelines Pregnancy Pregnant Women Prevention Prevention Research Prevention program Procedures Program Development Provider Public Health Qualitative Methods Records Research Research Methodology Research Personnel Resource-limited setting Risk Services Socioeconomic Status South Africa South African Southern Africa Spottings Surveys Tenofovir Time Training United States National Institutes of Health Universities Urban Health Vertical Disease Transmission Visit Vulnerable Populations Woman acceptability and feasibility antenatal antenatal care antiretroviral therapy base career cohort effective intervention experience follow-up high risk improved multidisciplinary pediatric human immunodeficiency virus infection perinatal HIV pill postnatal pre-exposure prophylaxis pregnant prevent research and development scale up seroconversion service delivery side effect social stigma substance use transmission process uptake young woman

项目摘要

Project Summary HIV-uninfected pregnant and breastfeeding women in South Africa are at high risk of HIV acquisition despite increased uptake of antiretroviral therapy (ART) and maternal seroconversion during pregnancy and breastfeeding contributes significantly toward pediatric HIV infections. Comprehensive HIV prevention programs that include biomedical interventions, such as pre-exposure prophylaxis (PrEP), could dramatically reduce HIV incidence in pregnant and breastfeeding women in high HIV incidence areas and reduce vertical HIV transmission. The overarching goal of this proposal is to evaluate the feasibility and acceptability of integrating PrEP into antenatal and postnatal care, to describe the cascade in women initiating PrEP in this setting, and to evaluate the reasons for attrition along the PrEP cascade in a cohort of pregnant and breastfeeding women Candidate: I am an HIV epidemiologist with a background in HIV research and program development, implementation in Africa. I am applying for a five-year Fogarty IRSDA K01 award to obtain training, mentorship, and research experience to become an independent investigator capable of obtaining R01 funding. Mentoring: I have put together an exceptional multi-disciplinary mentoring team with extensive experience in HIV prevention research in South Africa that integrates clinical research, epidemiology, PrEP and qualitative methods. Drs. Thomas Coates (UCLA) and Landon Myer (University of Cape Town, South Africa) will serve as co-Primary mentors and bring complementary expertise in behavioral science and clinical trials. In addition to my two Primary mentors, my co-mentors provide expertise in specific content areas and methodologies and are based in both the U.S. and South Africa. My co-mentorship team includes: Dr. Pamina Gorbach (U.S.-based, behavioural epidemiologist with significant experience in mixed methods research, Dr. Linda-Gail Bekker (SA-based, clinical trials, PrEP and research in young women). Training: Specific training in clinical trials, advanced biostatistics, behavioural science and mixed methods analysis, will be achieved through intensive mentored training, coursework, workshops and and primary research in South Africa. Guided by my mentorship team, these training and research experiences will establish my independent investigator career as an expert in research in pregnant and breastfeeding women in low resource settings. Research: The specific aims are to: (1) Evaluate the feasibility and acceptability of integrating PrEP into antenatal and postnatal/well-baby services; (2) Describe the PrEP cascade of initiation, retention, and adherence in a cohort of HIV-uninfected pregnant and breastfeeding women, (3) Evaluate attrition and associated factors across the PrEP cascade. The results from our study will provide a model to implement WHO guidance and scale-up PrEP delivery in pregnant and breastfeeding women at risk of HIV and contribute to the elimination of vertical HIV transmission. We will use the formative research to apply for a R01 grant to evaluate interventions to improve retention in the PrEP cascade in a larger cohort of pregnant and breastfeeding women.

项目摘要尽管抗逆转录病毒疗法（ART）和孕妇血清转化的摄取增加在怀孕期间母乳喂养对小儿艾滋病毒感染产生了重大贡献。全面的艾滋病毒预防包括生物医学干预措施的程序，例如预防前暴露（PREP）降低孕妇和母乳喂养妇女在高艾滋病毒发病率区域的发病率并减少垂直艾滋病毒传播。该提案的总体目标是评估将PREP整合到产后和产后护理中，以描述女性在此发起准备的级联设置，并评估在孕妇队列中沿预备级联流失的原因母乳喂养女性候选人：我是一名艾滋病毒流行病学家，具有艾滋病毒研究和计划背景发展，非洲实施。我正在申请五年的Fogarty Irsda K01奖培训，指导和研究经验，成为能够获得的独立研究者 R01资金。指导：我已经组建了一个杰出的多学科指导团队南非的HIV预防研究经验，该研究整合了临床研究，流行病学，PREP 和定性方法。博士。托马斯·科茨（UCLA）和兰登·迈尔（Landon Myer）（南部开普敦大学，南部非洲）将担任联合主要导师，并带来行为科学和临床方面的互补专业知识试验。除了我的两位主要导师外，我的联合主管还提供了特定内容领域的专业知识，方法论，位于美国和南非。我的会议团队包括：帕米纳博士戈尔巴赫（总部位于美国的行为流行病学家，在混合方法研究中拥有丰富经验，博士琳达 - 盖尔·贝克（Linda-Gail Bekker）（基于SA，临床试验，年轻女性的PREP和研究）。培训：具体培训将实现临床试验，高级生物统计学，行为科学和混合方法分析通过密集的指导培训，课程，讲习班以及南非的主要研究。指导通过我的指导团队，这些培训和研究经验将建立我的独立研究者在低资源环境中孕妇和母乳喂养妇女研究专家的职业。研究：具体目的是：（1）评估将PREP整合到产前的可行性和可接受性产后/宝贝服务；（2）描述在队列中的启动，保留和依从性的准备级联艾滋病毒未感染的孕妇和母乳喂养的妇女，（3）评估整个损耗和相关因素准备级联。我们研究的结果将为实施谁指导和扩大规模提供模型孕妇和母乳喂养的妇女的准备危险风险，并有助于消除垂直艾滋病毒传播。我们将使用形成性研究申请R01赠款，以评估干预措施改善较大的孕妇和母乳喂养妇女队列中预备级联的保留率。

项目成果

期刊论文数量（4）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Importance of rigorous implementation science studies to scale-up evidence-based interventions to end the HIV epidemic in the United States.

DOI：
10.1097/qad.0000000000002696
发表时间：
2021-02-02
期刊：
AIDS (London, England)
影响因子：
0
作者：
Joseph Davey DL;de Villiers L;Evens E
通讯作者：
Evens E

HIV testing and linkage to ART following secondary distribution of HIV self-test kits to male partners of women living with HIV: a pilot randomized control trial in Mpumalanga, South Africa.

DOI：
10.1002/jia2.25937
发表时间：
2022-06
期刊：
JOURNAL OF THE INTERNATIONAL AIDS SOCIETY
影响因子：
6
作者：
Joseph Davey, Dvora L.;Wall, Kristin M.;Naidoo, Nireshni;Naidoo, Dhirisha;Xaba, Gugu;Serao, Claire;Malone, Todd;Dovel, Kathryn
通讯作者：
Dovel, Kathryn

Changes in the Vaginal Microbiome During Pregnancy and the Postpartum Period in South African Women: a Longitudinal Study.