Evaluating the PrEP cascade in HIV-negative pregnant and breastfeeding women in South Africa (PrEP-PP)

评估南非 HIV 阴性孕妇和哺乳期妇女的 PrEP 级联 (PrEP-PP)

• 批准号: 10436266
• 负责人: DVORA JOSEPH DAVEY
• 金额: $ 47.03万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-15 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10436266
• 关键词: Adherence; Adverse event; Africa; Age; Awareness; Behavioral; Breast Feeding; Cells; Cohort Studies; Communication; Communities; Counseling; Country; Data; Disease; Ensure; Family; Female; Female Adolescents; Future; Genital; Genitalia; Government; Guidelines; HIV; HIV Infections; HIV Seronegativity; HIV-1; Health; Health Services; Health care facility; Hormonal Change; Incidence; Individual; Infection; Intervention; Knowledge; Letters; Meta-Analysis; Methods; Modeling; Mother-to-child HIV transmission; Mucous Membrane; Multiple Partners; Neonatal; Outcome; Participant; Patients; Perinatal; Perinatal transmission; Population; Populations at Risk; Postpartum Period; Postpartum Women; Predisposition; Pregnancy; Pregnant Women; Prevention; Primary Health Care; Provider; Risk; Sex Behavior; South Africa; South African; Surface; Tenofovir; Time; Unsafe Sex; Vertical Disease Transmission; Woman; antiretroviral therapy; cohort; effective intervention; high risk; mathematical model; pediatric human immunodeficiency virus infection; perinatal HIV; pill; pre-exposure prophylaxis; pregnant; prevent; programs; provider factors; risk perception; scale up; seroconversion; side effect; social stigma; substance use; transmission process; young woman

Project Summary/Abstract HIV-negative pregnant and breastfeeding women in South Africa are at extremely high risk of HIV acquisition despite increased access to and initiation of antiretroviral therapy (ART) in South Africa. We urgently need effective interventions to reduce HIV incidence in pregnant and breastfeeding women. Currently PrEP is one of the only female controlled methods that is effective for preventing HIV acquisition. PrEP-PP is a study of pre-exposure prophylaxis (PrEP) among HIV-1 seronegative Pregnant and Postpartum women in two South African urban primary health care facilities. Effective use of PrEP could contribute to eliminating maternal HIV acquisition, and hence eliminating mother to child HIV transmission (MTCT). However, PrEP efficacy requires adherence during periods of sexual activity and adherence requires PrEP access, awareness and counseling. Currently, a major obstacle in the field is the lack of knowledge of women's initiation, retention and adherence to PrEP during pregnancy and breastfeeding periods in Africa. Now is the time to evaluate how best to provide PrEP to vulnerable pregnant and breastfeeding women as WHO recently developed guidelines for providing PrEP in pregnancy and breastfeeding women but there are limited data on acceptability, initiation and adherence in pregnant and breastfeeding women in Africa where the burden of HIV is greatest. Our study will focus on the following specific aims: 1. Determine the distribution of women across the PrEP cascade (initiation, retention, and adherence) and outcomes (HIV acquisition, transmission, and adverse events) in a cohort of pregnant and breastfeeding women in Cape Town, South Africa 2. Evaluate patient and provider-level factors associated with the PrEP cascade (initiation, retention and adherence) using quantitative and qualitative approaches 3. Apply an established mathematical model to simulate the impact of improvement in the PrEP cascade on HIV infections averted (maternal and perinatal) Our PrEP-PP study is urgent and essential to understand the PrEP cascade in pregnant and breastfeeding women in South Africa and to identify factors associated with PrEP initiation and adherence to develop interventions to ensure that everyone in this at-risk population can benefit from PrEP. The results from the PrEP-PP study will provide a model for the South African Government, and other Governments in the region, to scale up PrEP delivery among pregnant and breastfeeding women at risk of HIV acquisition and perinatal transmission and contribute to the elimination of perinatal HIV transmission.

项目摘要/摘要 南非的HIV阴性怀孕和母乳喂养妇女的艾滋病毒风险极高 尽管在南非获得了抗逆转录病毒疗法（ART）的访问和启动，但获得了收购。我们 紧急需要有效的干预措施来减少孕妇和母乳喂养妇女的艾滋病毒发病率。 目前，PREP是唯一有效预防艾滋病毒收购的女性受控方法之一。 PREP-PP是HIV-1血清神经孕妇和产后的暴露前预防（PREP）的研究 南非两个城市初级卫生保健机构的妇女。有效使用准备可能有助于 消除孕产妇的艾滋病毒获取，从而消除母亲的艾滋病毒传播（MTCT）。 但是，准备疗效需要在性活动和遵守期间遵守性 访问，意识和咨询。目前，该领域的主要障碍是缺乏对妇女的了解 在非洲怀孕和母乳喂养期间的启动，保留和依从性。现在是 是时候评估如何最好地为脆弱的怀孕和母乳喂养的妇女做好准备 最近制定了提供怀孕和母乳喂养妇女准备的准则，但有限 关于非洲怀孕和母乳喂养妇女的可接受性，起始和依从性的数据 艾滋病毒是最伟大的。我们的研究将侧重于以下具体目标： 1。确定妇女在整个级联级联的分布（启动，保留和依从性）和 在孕妇和母乳喂养的队列中的结果（HIV获取，传播和不良事件） 南非开普敦的妇女 2。评估与准备级联相关的患者和提供者级别的因素（启动，保留和 使用定量和定性方法的依从性） 3。应用已建立的数学模型来模拟准备级联对改进的影响 避免HIV感染（孕产妇和围产期） 我们的PREP-PP研究迫切且至关重要，对于理解怀孕和 南非的母乳喂养妇女，并确定与准备和遵守有关的因素 制定干预措施以确保这种高危人群中的每个人都可以从准备中受益。结果 PreP-PP研究将为南非政府和该地区的其他政府提供模型， 扩大怀孕和母乳喂养的妇女的准备，有艾滋病毒和围产期的风险 传播并有助于消除围产期艾滋病毒的传播。

项目成果

Psychosocial determinants of pre-exposure prophylaxis use among pregnant adolescent girls and young women in Cape Town, South Africa: A qualitative study.

南非开普敦怀孕少女和年轻妇女暴露前预防使用的心理社会决定因素：一项定性研究。

• DOI: 10.1177/09564624231152776
• 发表时间: 2023
• 期刊: International journal of STD & AIDS
• 影响因子: 1.4
• 作者: Haribhai,Sonia;Khadka,Nehaa;Mvududu,Rufaro;Mashele,Nyiko;Bekker,Linda-Gail;Gorbach,Pamina;Coates,ThomasJ;Myer,Landon;JosephDavey,DvoraLeah
• 通讯作者: JosephDavey,DvoraLeah

"I had Made the Decision, and No One was Going to Stop Me" -Facilitators of PrEP Adherence During Pregnancy and Postpartum in Cape Town, South Africa.

• DOI: 10.1007/s10461-021-03320-x
• 发表时间: 2021-12
• 期刊: AIDS and behavior
• 影响因子: 4.4
• 作者: Joseph Davey DL;Knight L;Markt-Maloney J;Tsawe N;Gomba Y;Mashele N;Dovel K;Gorbach P;Bekker LG;Coates TJ;Myer L
• 通讯作者: Myer L

Maternal PrEP Use in HIV-Uninfected Pregnant Women in South Africa: Role of Stigma in PrEP Initiation, Retention and Adherence.

• DOI: 10.1007/s10461-021-03374-x
• 发表时间: 2022-01
• 期刊: AIDS and behavior
• 影响因子: 4.4
• 作者: Moran A;Mashele N;Mvududu R;Gorbach P;Bekker LG;Coates TJ;Myer L;Joseph Davey D
• 通讯作者: Joseph Davey D

Urgent appeal to implement pre-exposure prophylaxis for pregnant and breastfeeding women in South Africa.

紧急呼吁对南非孕妇和哺乳期妇女实施暴露前预防。

• 发表时间: 2021
• 期刊: South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde
• 作者: JosephDavey,DL;Davies,N;Raphael,Y;Pillay,Y;Bekker,L-G
• 通讯作者: Bekker,L-G

Evaluating the use of oral pre-exposure prophylaxis among pregnant and postpartum adolescent girls and young women in Cape Town, South Africa.

• DOI: 10.3389/frph.2023.1224474
• 发表时间: 2023
• 期刊: FRONTIERS IN REPRODUCTIVE HEALTH
• 作者: Khadka, Nehaa;Gorbach, Pamina M;Nyemba, Dorothy C;Mvududu, Rufaro;Mashele, Nyiko;Javanbakht, Marjan;Nianogo, Roch A;Aldrovandi, Grace M;Bekker, Linda-Gail;Coates, Thomas J;Myer, Landon;Joseph Davey, Dvora L
• 通讯作者: Joseph Davey, Dvora L