Screening strategies for sexually transmitted infections in a high HIV incidence setting in South Africa

南非艾滋病毒高发地区的性传播感染筛查策略

基本信息

批准号：
10761853
负责人：
Jana Jarolimova
金额：
$ 19.76万
依托单位：
MASSACHUSETTS GENERAL HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-09-01 至 2028-08-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10761853
关键词：
AIDS prevention Address Adolescent and Young Adult Adoption Affect Africa Africa South of the Sahara African Biometry Biostatistical Methods Caring Chlamydia Clinic Clinical Clinical Investigator Clinical Trials Clinical Trials Design Cohort Studies Collaborations Communicable Diseases Communities Country Data Diagnostic Diagnostic tests Effectiveness Enrollment Epidemiology Etiology Evaluation Face Foundations Funding Future Goals Gonorrhea Guidelines HIV HIV Infections HIV/TB Health Health Services Heterogeneity Home Human immunodeficiency virus test Incidence Income Individual Infrastructure Interview K-Series Research Career Programs Left Location Measures Mentors Mentorship Methods Modeling Morbidity - disease rate Motivation NIH Office of AIDS Research Nurses Parents Participant Pelvic Inflammatory Disease Persons Physicians Play Population Practical Robust Implementation and Sustainability Model Pregnancy Complications Prevalence Process Measure Provider Qualitative Methods Qualitative Research Reach, Effectiveness, Adoption, Implementation, and Maintenance Recommendation Reproductive Health Research Research Infrastructure Research Institute Research Methodology Research Personnel Research Priority Risk Role STI prevention Sample Size Sampling Self Care Sensitivity and Specificity Sexual Health Sexually Transmitted Diseases South Africa Specimen Symptoms Testing Time Training Trichomonas Infections United States National Institutes of Health Woman Work accurate diagnostics behavior change career clinical epidemiology co-infection design didactic education effectiveness evaluation experimental study future implementation high risk home test implementation determinants implementation evaluation implementation research implementation science improved infection management interest low and middle-income countries men multidisciplinary novel pathogen peer point of care testing pre-exposure prophylaxis preference primary outcome rapid testing rural South Africa sample collection scale up screening screening program sexual health intervention skills standard of care structural determinants transmission process tubal infertility uptake young woman

项目摘要

PROJECT SUMMARY Curable sexually transmitted infections (STIs) are highly prevalent among adolescents and young adults in sub-Saharan Africa, who are also at the highest risk of acquiring HIV. Untreated STIs, such as gonorrhea, chlamydia, and trichomoniasis, increase HIV acquisition and transmission risks and can lead to significant morbidity for women, including pelvic inflammatory disease, tubal infertility, and pregnancy complications. Faced by constraints in diagnostic capacity, many countries rely on syndromic management, which has poor sensitivity and specificity, particularly because the majority of curable STIs are asymptomatic. As accurate diagnostic tests for STIs are developed, effective screening strategies to reach populations at high risk for STIs and HIV, such as adolescents and young adults in rural South Africa, need to be rigorously evaluated to inform the future implementation of STI screening programs. I am an Infectious Disease physician with a background in clinical epidemiology and an interest in decreasing the burden of STIs and their contribution to HIV transmission in sub-Saharan Africa. I am motivated to pursue training to apply new methods to the design and evaluation of STI screening strategies in rural South Africa. The NIH K23 Mentored Research Career Development Award will afford me the opportunity to gain the necessary skills to become an independent clinician investigator. I will pursue training in (1) qualitative research methods, (2) discrete choice analysis and clinical trial design, and (3) implementation science methods and frameworks. I have designed a didactic curriculum to address each of these training aims and assembled a multidisciplinary mentorship team. My primary mentor is Dr. Ingrid Bassett, an expert in cohort studies and implementation research to evaluate HIV and tuberculosis linkage to care in South Africa. My mentorship team additionally includes experts in community-based, peer-led interventions for sexual health and HIV prevention in South Africa (Dr. Maryam Shahmanesh), qualitative research (Dr. Christina Psaros), and biostatistics (Dr. Robert Parker). With their guidance, I will assess young people’s preferences for STI screening and design and evaluate a community- based STI screening strategy in rural South Africa through the following specific aims: 1) Evaluate motivation and preferences for STI screening among adolescents and young adults using qualitative methods, 2) Conduct a Discrete Choice Experiment to quantify young people’s preferences for community-based STI screening, and 3) Evaluate the implementation of a new community-based STI screening strategy among adolescents and young adults. I will deepen an existing collaboration with the Africa Health Research Institute (AHRI), leveraging the infrastructure of a funded clinical trial. The proposed training and research aims will inform future efforts to expand STI screening in South Africa, and will provide a strong foundation for my career as an independent clinician investigator focused at the intersection of STIs and HIV prevention.

项目摘要在青少年和年轻人中，可治愈的性传播感染（性传播感染）非常普遍撒哈拉以南非洲，他们也处于获取艾滋病毒的最高风险。未经处理的性传播感染，例如淋病，衣原体和trichomonisis增加了艾滋病毒的收购和传播风险，可能导致重大女性的发病率，包括骨盆炎症性疾病，输卵管不育症和妊娠并发症。在诊断能力的限制下，许多国家都依赖综合症管理，而综合症管理很差敏感性和特异性，特别是因为大多数可治愈性传播感染都是无症状的。准确开发了性传播感染的诊断测试，有效的筛查策略以达到ETI高风险的人群需要严格评估艾滋病毒，例如南非农村的青少年和年轻人，以告知 STI筛查计划的未来实施。我是一个具有背景的传染病医师在临床流行病学以及对减少性传播感染及其对艾滋病毒的贡献的兴趣中在撒哈拉以南非洲的传播。我有动力继续培训，将新方法应用于设计和评估南非农村地区的STI筛查策略。 NIH K23指导研究职业开发奖将使我有机会获得必要的技能，成为独立临床研究者。我将在（1）定性研究方法，（2）离散选择分析和临床试验设计以及（3）实施科学方法和框架。我设计了一个教学法课程以解决这些培训的目标，并组建了一个多学科的心态团队。我的主要的心理是同类研究和实施研究专家Ingrid Bassett博士，以评估HIV 和结核病与南非的护理联系。我的攻击团队还包括南非以社区为基础的，以同伴为主导的性健康和艾滋病毒预防干预措施（Maryam博士 Shahmanesh），定性研究（Christina Psaros博士）和生物统计学（Robert Parker博士）。与他们指导，我将评估年轻人对STI筛查和设计和评估社区的偏好 - 通过以下特定目的，基于南非的基于基于的STI筛查策略：1）评估动机以及使用定性方法在青少年和年轻人之间进行性传播感染筛查的偏好，2）进行一个离散的选择实验，以量化年轻人对基于社区的性传播感染筛查的偏好，以及 3）评估青少年和年轻人。我将加深与非洲健康研究所（AHRI）的现有合作，利用基础临床试验的基础设施。拟议的培训和研究目标将告知未来在南非扩大性传播疾病筛查的努力，并将为我的职业生涯奠定坚实的基础独立的临床研究者着重于性传播感染和HIV预防的交集。