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: 9976615
• 负责人: Thomas J. Coates
• 金额: $ 48.82万
• 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 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9976615
• 关键词: Adherence; Adverse event; Africa; Age; Alcohol or Other Drugs use; Awareness; Behavioral; Breast Feeding; Cells; Cohort Studies; Communication; Communities; Counseling; Country; Data; Disease; Ensure; Family; Female; Female Adolescents; Future; Genital system; 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; risk perception; scale up; seroconversion; side effect; social stigma; 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.

项目概要/摘要 南非艾滋病毒呈阴性的孕妇和哺乳期妇女感染艾滋病毒的风险极高 尽管南非获得和开始抗逆转录病毒治疗（ART）的机会有所增加。我们 迫切需要采取有效的干预措施来降低孕妇和哺乳期妇女的艾滋病毒感染率。 目前，PrEP 是唯一能有效预防 HIV 感染的女性控制方法之一。 PrEP-PP 是一项 HIV-1 血清阴性孕妇和产后暴露前预防 (PrEP) 的研究 南非两个城市初级卫生保健机构中的妇女。有效使用 PrEP 可能有助于 消除孕产妇感染艾滋病毒，从而消除艾滋病毒母婴传播（MTCT）。 然而，PrEP 的功效需要在性活动期间坚持，而坚持需要 PrEP 访问、意识和咨询。目前，该领域的一个主要障碍是缺乏对妇女问题的了解。 非洲怀孕和哺乳期间开始、保留和坚持 PrEP 的情况。现在是 是时候像世界卫生组织一样评估如何最好地向弱势孕妇和哺乳期妇女提供 PrEP 了 最近制定了为怀孕和哺乳期妇女提供 PrEP 的指南，但限制有限 关于非洲孕妇和哺乳期妇女的可接受性、开始和坚持的数据，这些妇女的负担 艾滋病病毒感染率最高。我们的研究将重点关注以下具体目标： 1. 确定女性在 PrEP 级联中的分布（启动、保留和坚持）以及 妊娠期和哺乳期人群的结果（HIV 感染、传播和不良事件） 南非开普敦的妇女 2. 评估与 PrEP 级联相关的患者和提供者层面的因素（启动、保留和 坚持）使用定量和定性方法 3. 应用已建立的数学模型来模拟 PrEP 级联改进对 避免艾滋病毒感染（孕产妇和围产期） 我们的 PrEP-PP 研究对于了解怀孕和怀孕期间的 PrEP 级联至关重要。 南非的母乳喂养妇女，并确定与 PrEP 启动和坚持相关的因素 制定干预措施，确保高危人群中的每个人都能从 PrEP 中受益。结果来自 PrEP-PP 研究将为南非政府和该地区其他政府提供一个模型， 扩大对有艾滋病毒感染风险和围产期孕妇和哺乳期妇女的 PrEP 实施范围 传播并有助于消除围产期艾滋病毒传播。