STI Response and Recommendations Under PrEP (STIRRUP)

PrEP (STIRRUP) 下的性传播感染应对和建议

• 批准号: 10555335
• 负责人: Samuel Jenness
• 金额: $ 59.47万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-02-01 至 2026-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10555335
• 关键词: AIDS prevention; Acceleration; Accounting; Address; African American; Behavioral; Big Data; Black race; Boston; Caring; Chlamydia; Cities; Clinical; Continuity of Patient Care; Data; Detection; Development; Diagnosis; Disease; Economic Models; Economics; Electronic Health Record; Epidemic; Epidemiology; Ethics; Ethnic Origin; Etiology; Genitourinary system; Geography; Goals; Gonorrhea; Guidelines; HIV; Health Policy; Heterogeneity; Incidence; Infection; Intervention; Link; Mental Health; Modeling; Modernization; Network-based; Pattern; Pharyngeal structure; Policies; Population; Prevention; Privatization; Public Health; Race; Recommendation; Recording of previous events; Rectum; Resources; Risk; STI prevention; Science; Services; Sex Behavior; Sexually Transmitted Diseases; Shapes; Site; Swab; Syphilis; Testing; Uncertainty; United States; Unsafe Sex; Variant; Visit; black men who have sex with men; burden of illness; clinical practice; condoms; cost; cost effectiveness; cost estimate; data integration; data streams; demographics; design; disparity reduction; epidemiology study; ethnic disparity; falls; geographic difference; health care settings; high risk men; improved; infection burden; infection rate; mathematical model; men; men who have sex with men; men' s group; pre-exposure prophylaxis; prevent; prevention service; programs; racial disparity; rectal; response; routine screening; scale up; screening; sexual risk behavior; success; theories; transmission process

ABSTRACT STIRRUP (STI Responses and Recommendations Under PrEP) combines big data streams with mathemat- ical modeling and economic decision science to understand the optimal design of STI screening in PrEP care. Cases of gonorrhea, chlamydia, and syphilis have increased substantially over the past decade and a dispro- portionate disease burden falls on men who have sex with men (MSM). The persistently high STI rates among MSM are driven by the high proportion of asymptomatic infections and low rates of routine screening that would detect these infections. Most MSM who use PrEP are at elevated risk of acquiring STIs. PrEP care therefore provides a critical opportunity to reach and clinically engage a population who could benefit from linked HIV and STI prevention services. Screening for STIs in PrEP care following CDC recommendations can counterbalance the effects of increases in sexual risk behavior by treating asymptomatic STIs to prevent ongo- ing STI transmission chains. However, patterns of STI screening in PrEP care are far from recommended levels, with substantial variation by demographics and geography. Models informing clinical practice and public health policy must therefore incorporate data streams that span the range of healthcare settings where PrEP care is offered to these groups, and where it can be improved. Following an Extended, Multi-Disease PrEP Continuum of Care that includes steps for STI ancillary services and PrEP retention, we seek to test a leading hypothesis about the bidirectionality of these two steps: that ongoing comprehensive PrEP care is an efficient mechanism for routine STI screening and treatment, but that frequent STI ancillary services may often be a burden to retention in PrEP care. STIRRUP includes three SPECIFIC AIMS: AIM 1. We will extract, collect, analyze, and synthesize information on PrEP care, sexual behavior, mental health diagnoses, and HIV/STI screening patterns for MSM from electronic health records and epidemiological studies in three types of PrEP programs (academic, public, and private) in two geographic settings (Boston and Atlanta) distinguished by their HIV/STI burden and demographics. Analyses will guide development of an ethical framework for big data in modeling. AIM 2. With these data, we will build network-based race-stratified transmission models of four co- circulating infections (HIV, chlamydia, syphilis, and gonorrhea) among MSM at three exposure sites (urogeni- tal, rectal, and pharyngeal). These models will investigate the relationship between PrEP use and HIV/STI incidence given current bacterial STI screening/treatment (pre- and post-PrEP initiation), with a theory-driven focus on racial/ethnic disparities and mental health predictors across and within each city. AIM 3. We will eval- uate public health policies and clinical practice strategies for screening and treatment of STIs among heterogenous groups of MSM using PrEP. Economic models will estimate the cost-effectiveness of policies individualized to clinical histories, and evaluate the optimal approach to targeting societal resources to reduce out-of-pocket user costs for ancillary PrEP services that could improve long-term PrEP retention.

抽象的 Stirrup（PREP下的STI响应和建议）将大数据流与数学结合在一起 ICAL建模和经济决策科学，以了解预备护理中STI筛查的最佳设计。 在过去的十年中，淋病，衣原体和梅毒的病例大大增加 分区疾病负担属于与男性发生性关系的男性（MSM）。 STI持续高的速率 MSM是由高比例的无症状感染和常规筛查率较低的驱动的。 将检测这些感染。大多数使用PREP的MSM都具有获取性传播感染的风险较高。准备护理 因此，提供了一个至关重要的机会，可以从中受益 链接的HIV和STI预防服务。按照疾病预防疾护建议的建议，在预先护理中筛选性传播感染可以 平衡通过治疗无症状性传播疾病以防止ongo- ING STI传输链。但是，预备护理中的性传播感染筛查模式远非推荐 水平，人口统计和地理的差异很大。告知临床实践和公众的模型 因此，健康政策必须结合跨越预备的医疗机构范围的数据流 为这些小组提供护理，并可以改进。遵循延长的多疾病准备 连续护理，包括STI辅助服务和预备率的步骤，我们试图测试领先的 关于这两个步骤的双向性的假设：正在进行的全面准备护理是一个有效的 常规性STI筛查和治疗的机制，但是经常使用的STI辅助服务通常是 保留预科护理的负担。马rup包括三个具体目标：目标1。我们将提取，收集， 分析并综合有关准备护理，性行为，心理健康诊断和HIV/STI的信息 从电子健康记录和流行病学研究中的三种类型的PREP中的MSM筛选模式 在两个地理环境（波士顿和亚特兰大）中的计划（学术，公共和私人）以其 艾滋病毒/STI负担和人口统计。分析将指导开发大数据的道德框架 造型。 AIM 2。通过这些数据，我们将建立基于网络的种族分层的传输模型 在三个暴露部位的MSM中循环感染（HIV，衣原体，梅毒和淋病）（urogen- TAL，直肠和咽）。这些模型将研究准备使用与HIV/STI之间的关系 鉴于当前细菌性传播性STI筛查/治疗（PERE-PERPET和PEES PREP启动）的发病率，理论驱动 专注于每个城市内外的种族/种族差异和心理健康预测因素。目标3。我们将评估 - UATE公共卫生政策和临床实践策略，用于筛选和治疗性传播感染 使用PREP的MSM异质组。经济模型将估计政策的成本效益 个性化至临床历史，并评估针对社会资源以减少社会资源的最佳方法 辅助预备服务的自付费用成本可以改善长期预备率。