Developing a risk assessment tool to identify HIV-uninfected adolescent girls and young women at highest risk for HIV infection: a key step for targeted biomedical HIV prevention

开发风险评估工具来识别艾滋病毒感染风险最高的未感染艾滋病毒的少女和年轻妇女：有针对性的生物医学艾滋病毒预防的关键步骤

• 批准号: 10375594
• 负责人: Nora Rosenberg
• 金额: $ 19.44万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-04-01 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10375594
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Address; Adherence; Africa South of the Sahara; African; Age-Years; Algorithms; Area; Assessment tool; Biological Markers; Biometry; Cameroon; Characteristics; Clinical; Complex; Country; Data; Development; Emergency Situation; Epidemic; Epidemiologic Factors; Epidemiology; Ethiopia; Female; Female Adolescents; Goals; HIV; HIV Infections; HIV-infected adolescents; Health; High Risk Woman; Household; Incidence; Individual; Infant; Infection; Intervention; Intervention Studies; Ivory Coast; Kenya; Laboratories; Lasso; Lesotho; Machine Learning; Malawi; Measures; Methodology; Methods; Modeling; Namibia; Oral; Outcome; Performance; Persons; Population; Pregnancy; Prevention strategy; Principal Investigator; Receiver Operating Characteristics; Research; Research Personnel; Risk; Risk Assessment; Risk Factors; Rwanda; Sampling; Sensitivity and Specificity; Surveys; Tanzania; Techniques; Tenofovir; Testing; UNICEF; Uganda; Validation; Woman; World Health Organization; Zambia; Zimbabwe; adolescent HIV prevention; adverse outcome; age group; base; career; clinical risk; experience; high risk; high-risk adolescents; implementation science; improved; model development; multidisciplinary; population based; pre-exposure prophylaxis; predictive modeling; programs; tool; transmission process; young woman

PROJECT SUMMARY/ABSTRACT Background: In sub-Saharan Africa (SSA), adolescent girls and young women (AGYW) 15-24 years of age remain at epicenter of the HIV epidemic, with more than 270,000 new HIV infections each year. Biomedical HIV prevention strategies like tenofovir-based oral pre-exposure prophylaxis (PrEP) are promising measures for reducing HIV acquisition in AGYW. However, providing PrEP to all 100 million AGYW in SSA is not feasible, economical, or necessary, as the risk of HIV acquisition among AGYW is not uniformly high. Risk assessment tools are needed to identify those AGYW sub-populations at greatest risk for acquiring HIV in order to support targeted PrEP program implementation. Existing risk assessment tools for HIV incidence in AGYW have had important limitations surrounding feasibility, validity, and generalizability. The primary goal of this project is to develop a regional risk assessment tool for AGYW that is feasible to implement, valid, and generalizable. Our overarching premise is that risk of HIV acquisition among AGYW is not uniform and it is possible to identify high risk AGYW at a regional level. Aims and Methods: Using nationally representative data from 13 African countries collected as part of the Population-based HIV Impact Assessment (PHIA) initiative, our team will address this premise through three specific aims. In the first aim, we will explore risk factors associated with recent HIV infection, a marker of incident HIV, among AGYW. Recent infection is defined in the PHIA data using a well-established testing algorithm. Using data from 13 PHIA surveys from 2015-2019, which include >50,000 observations, individual, structural, household, and epidemiologic predictors of recent HIV infection among AGYW will be identified. In the second aim, we will use the candidate predictors from the first aim to develop and internally validate a risk assessment tool to identify AGYW at highest risk of HIV acquisition. In the third aim, we will externally validate the risk assessment tool in five second-round PHIA surveys from 2020. Team: The team, led by an early-career Principal Investigator, has expertise in HIV prevention for AGYW, biomedical HIV prevention, risk score development, and advanced methods for complex survey data. The team is supported by a technical advisory panel of experts from multiple SSA regions. Expected Impact: These findings will provide an in-depth understanding of the current transmission dynamics of HIV among AGYW in SSA. At the end of the study, we expect to have a validated clinical risk assessment tool that can be applied to a range of SSA settings. Such a tool has the potential to transform the clinical delivery of PrEP and other biomedical HIV prevention strategies in SSA.

项目概要/摘要 背景：在撒哈拉以南非洲 (SSA)，15-24 岁的少女和年轻女性 (AGYW) 仍然是艾滋病毒流行的中心，每年新增艾滋病毒感染人数超过 27 万。生物医学艾滋病毒 基于替诺福韦的口服暴露前预防 (PrEP) 等预防策略是有希望的措施 减少 AGYW 中的艾滋病毒感染。然而，向 SSA 的所有 1 亿 AGYW 提供 PrEP 是不可行的， 经济的或必要的，因为 AGYW 感染艾滋病毒的风险并不都很高。风险评估 需要工具来识别那些感染艾滋病毒风险最大的 AGYW 亚人群，以便支持 有针对性的 PrEP 计划实施。 AGYW 中艾滋病毒发病率的现有风险评估工具已经 围绕可行性、有效性和普遍性的重要限制。该项目的主要目标是 为 AGYW 开发一个可行、有效且可推广的区域风险评估工具。我们的 总体前提是，AGYW 中感染艾滋病毒的风险并不统一，并且有可能识别出高风险人群。 区域层面的 AGYW 风险。 目标和方法：使用来自 13 个非洲国家的国家代表性数据，这些数据是作为 基于人群的艾滋病毒影响评估 (PHIA) 倡议，我们的团队将通过三个方面来解决这一前提 具体目标。在第一个目标中，我们将探讨与近期艾滋病毒感染相关的风险因素，这是事件的标志 AGYW 中的艾滋病毒。使用完善的测试算法在 PHIA 数据中定义近期感染。 使用 2015 年至 2019 年 13 项 PHIA 调查的数据，其中包括超过 50,000 个观察结果，包括个体、结构、 将确定 AGYW 中近期 HIV 感染的家庭和流行病学预测因素。在第二个 目标，我们将使用第一个目标中的候选预测变量来开发和内部验证风险评估 识别 AGYW 感染 HIV 风险最高的工具。第三个目标，我们将从外部验证风险 2020 年起五次第二轮 PHIA 调查的评估工具。 团队：该团队由一位职业生涯早期的首席研究员领导，拥有 AGYW 艾滋病毒预防方面的专业知识， 生物医学艾滋病毒预防、风险评分开发以及复杂调查数据的先进方法。团队 由来自多个 SSA 地区的专家组成的技术顾问小组提供支持。 预期影响：这些发现将提供对当前传输动态的深入了解 SSA 地区 AGYW 中的艾滋病毒感染情况。在研究结束时，我们期望拥有经过验证的临床风险评估工具 可应用于一系列 SSA 设置。这样的工具有可能改变临床交付 SSA 中的 PrEP 和其他艾滋病毒生物医学预防策略。