Integrating expedited partner STI therapy during PrEP delivery for young women

在年轻女性的 PrEP 分娩过程中整合快速伴侣性传播感染治疗

基本信息

批准号：
10466894
负责人：
Jennifer Ellen Balkus
金额：
$ 79.59万
依托单位：
UNIVERSITY OF WASHINGTON
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-09-22 至 2023-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10466894
关键词：
Chlamydia trachomatis Clinical Trials Collaborations Cost Analysis Counseling Dapivirine Data Data Analyses Diagnostic tests Disclosure Ectopic Pregnancy Educational workshop Enrollment Exposure to Female Adolescents Fright Goals Guidelines HIV HIV-1 Health Personnel High Risk Woman Incidence Infection Infertility Interview Knowledge Lead Methods Modality Neisseria gonorrhoeae Oral Outcome Participant Pelvic Inflammatory Disease Persons Play Policy Maker Population Populations at Risk Prevention Prevention Research Process Prospective cohort study Public Health Recommendation Recurrence Reporting Reproductive Health Research Resources Risk Role STI prevention Sampling Sexual Health Sexual Partners Sexually Transmitted Diseases South Africa South African Sustainable Development Swab Symptoms Syndrome Syphilis Serodiagnosis Target Populations Testing Time Trichomonas vaginalis Vagina Vaginal Ring Visit Woman acceptability and feasibility aged chronic infection comparative cost cost estimate experience follow-up high standard implementation evaluation infection rate interest low and middle-income countries male microcosting neonatal infection peer point of care point of care testing point-of-care diagnostics pre-exposure prophylaxis prevent rapid test scale up screening sexual HIV transmission social standard of care uptake young woman

项目摘要

PROJECT SUMMARY Adolescent girls and young women (AGYW) in South Africa have one of the highest HIV-1 incidences globally and are a key target population for oral pre-exposure prophylaxis (PrEP) to prevent HIV-1 acquisition. In addition, AGYW seeking PrEP frequently experience high rates of curable sexually transmitted infections (STIs). Current South African PrEP guidelines recommend syndromic management for STIs, meaning that only women reporting symptoms will receive treatment. It is well-established that syndromic management is particularly problematic for women as the vast majority of curable STIs are asymptomatic. Persistent, untreated infections can lead to serious reproductive health outcomes, including pelvic inflammatory disease, infertility, ectopic pregnancy, neonatal infections, and increased risk HIV-1 acquisition. The high STI incidence in AGYW, which is on the rise, emphasizes the need for effective screening strategies to reduce rates of STIs and their associated impact on sexual and reproductive health outcomes. Among women who are at risk for HIV-1 and interested in initiating PrEP, point-of-care diagnostic STI testing and expedited partner therapy (EPT) are two strategies that could have a substantial impact on STI incidence. Few studies have evaluated the feasibility and acceptability of EPT in low and middle-income countries and, to date, no studies have assessed the implementation of point-of-care STI testing and EPT in the context of PrEP scale-up. This proposal builds on nearly a decade of collaborative HIV/STI prevention research to conduct a prospective cohort study of AGYW eligible for PrEP in South Africa in which we will assess the acceptability of point-of-care STI testing plus EPT and its impact on the incidence of common curable STIs over 12 months of follow-up (Aims 1 and 2). We will undertake qualitative interviews with participants and their male partners to identify facilitators and barriers to EPT uptake (Aim 2) and conduct a comparative cost analysis to estimate the cost per person tested using point-of-care STI testing with and without EPT incremental to the cost of standard of care (Aim 3). Findings from the proposed research will provide essential knowledge for national policy makers to advance approaches to STI screening and treatment that will lead to reductions in STIs and improvements in AGYW sexual reproductive health. The data generated from this proposal are essential to inform efforts to reduce the burden of STIs and HIV-1 in women achieve the 2030 Sustainable Development Goals, which includes substantial reductions in HIV and STIs in key at-risk populations.

项目摘要南非的青春期女孩和年轻女性（AGYW）在全球范围内是HIV-1最高的事件之一并且是口服预防前预防（PREP）的关键目标，以防止HIV-1采集。此外，寻求PREP的AGYW经常会经历高可治愈的性传播感染率（STIS）。当前的南非预科指南建议性传播疾病的综合症管理，这意味着只有妇女进行报告症状将接受治疗。公认的是综合症管理特别有问题对于女性而言，作为绝大多数可治愈性传播感染的女性都是无症状的。持续，未经治疗的感染可能导致严重的生殖健康结果，包括盆腔炎症性疾病，不育症，异位妊娠，新生儿感染，增加了风险HIV-1的获取。 AGYW的高性病发病率正在上升，强调需要有效筛选策略来降低性传播感染速度及其对其对影响的影响性和生殖健康结果。在有HIV-1风险并有兴趣发起的妇女中准备，即时护理点诊断性传播疾病测试和加急合作疗法（EPT）是两种策略，可以对性传播感染发病率有重大影响。很少有研究评估EPT的可行性和可接受性在低收入和中等收入国家，迄今为止，尚无研究评估护理的实施 STI测试和EPT在准备量表的背景下。该建议建立在近十年的合作基础上艾滋病毒/STI预防研究，以在南非有资格进行AGYW的前瞻性队列研究我们将评估Care Point STI测试的可接受性以及EPT及其对发病率的影响在12个月的随访中，常见的可治愈性传播感染（目标1和2）。我们将与参与者及其男性伴侣确定促进者和EPT吸收的障碍（AIM 2）并进行比较成本分析以估计使用有或没有的护理STI测试测试的每人的成本 EPT逐渐达到护理标准成本（AIM 3）。拟议研究的发现将提供国家政策制定者的基本知识，以推进STI筛查和治疗方法导致STI的减少和AGYW性生殖健康的改善。从中生成的数据提议对于减轻女性的性传播感染和HIV-1负担的努力至关重要可持续发展目标，其中包括主要危险人群中的艾滋病毒和性传播感染的大幅减少。