Increased risk of STI and HIV among adolescent girls and young women due to COVID-19 and pandemic mitigation: Biological, behavioral, and psychosocial mediators

由于 COVID-19 和流行病缓解措施，青春期女孩和年轻女性感染性传播感染和艾滋病毒的风险增加：生物、行为和社会心理调节因素

• 批准号: 10582165
• 负责人: Supriya Dinesh Mehta
• 金额: $ 68万
• 依托单位: RUSH UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-19 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10582165
• 关键词: Adolescent; Africa; Age; Anxiety; Area; Bacterial Vaginosis; Behavior; Behavioral; Biological; COVID-19; COVID-19 impact; COVID-19 pandemic; COVID-19 pandemic effects; COVID-19 risk; Caring; Cessation of life; Characteristics; Chlamydia; Communities; Complex; Crime; Data; Economics; Enrollment; Environment; Estradiol; Estrogens; Evaluation; Female Adolescents; Focus Groups; Future; Goals; Gonorrhea; Guidelines; HIV; HIV Infections; Health Personnel; High School Student; Hormonal; Household; Housing; Human Herpesvirus 2; Human immunodeficiency virus test; Hydrocortisone; Income; Individual; Interpersonal Violence; Intervention; Kenya; Knowledge; Lactobacillus; Logistics; Measures; Mediating; Mediation; Mediator of activation protein; Mental Depression; Natural Disasters; Outcome; Parents; Perception; Policies; Population; Pregnancy; Prevalence; Procedures; Publishing; Reporting; Reproductive Health; Research; Risk; Rural; Safety; Schools; Secondary Schools; Series; Sexual Health; Sexual Partners; Sexually Transmitted Diseases; Socioeconomic Factors; Source; Specimen; Stress; Structure; Time; Trichomonas; Trichomonas Infections; Vagina; Violence; Visit; Water; Youth; adolescent health; aged; cohort; coronavirus disease; depressive symptoms; experience; follow-up; food security; girls; global health; hazard; infection risk; low and middle-income countries; microbiome composition; pandemic disease; post-COVID-19; prevent; psychosocial; response; rural area; social; socioeconomics; stressor; teacher; therapy development; tool; vaginal microbiome; young woman

From late March 2020, in response to COVID-19, Kenya began a lockdown including shuttering schools. On 16th October, rising seniors could return to school to prepare for exams. In western Kenya, where among girls aged 15-19 HIV prevalence is 8.8% and HSV-2 prevalence is 28%, school closures likely have profound and lasting effects on HIV and sexually transmitted infection (STI) risk. Within a cohort of 436 secondary school girls, we are evaluating the effect of menstrual cups on the vaginal microbiome (VMB), Bacterial vaginosis (BV), and STIs. On October 1, we initiated the 30-month visit, having followed up 371 (85%) girls by December 18. The prevalence of BV was 21.8%, and 15.6% for chlamydia, gonorrhea, or trichomonas, representing a 55% increase in BV since last measure at the 18-month visit (14%), and 34% increase in STI since last measure at the 12-month evaluation (11.6%). Adjusted for socioeconomic factors, girls reporting high COVID- related stress and interpersonal violence had increased odds of BV and STI. Adolescents are especially sensitive to stress induced effects on the hypopituitary axis; increased stress and subsequent rise in cortisol leads to reduced estrogen, which is necessary to support the Lactobacillus crispatus dominant environment that helps prevent BV, STIs, and HIV. This study proposes to measure the socioeconomic, behavioral, and psychosocial impact of the COVID-19 crisis, how this relates to girls’ sexual exposures, and subsequent risk of BV, STI, and HIV. In Aim 1, we will quantify the economic, psychosocial, and behavioral impacts of COVID-19 and associated lockdowns and restrictions. Individual and village level assessments include changes in food security, water access, household income, violence, crime, and safety. Individual measures include extensive sexual practices, anxiety, depressive symptoms, interpersonal violence. In Aim 2, we will measure the association of COVID-19 stressors on risk for HIV and STIs. We will be able to estimate the hazard of STI and HIV outcomes under multiple conditions: pre-COVID (April 2018-October 2019), during COVID/school closures (since March 2020), during COVID/school reopening (anticipated), post-COVID (anticipated). In Aim 3, we will measure cortisol and estradiol and correlate this to reported stress, and quantify the influence of these biological measures of stress on VMB composition and subsequent BV, STI, and HIV. To understand girls’ own perceptions of and reasoning for behavioral and contextual changes, and to apply this to intervention development, we will employ a series of semi-structured focus group discussions. Implications: This study will provide detailed understanding of the financial, social, and behavioral impacts of COVID-19 and mitigation efforts on adolescent girls in rural areas of Africa as exemplified by this area of western Kenya. We will be able to examine this in relation to biological outcomes – VMB, BV, STI, HIV. The knowledge gained will directly contribute to intervention development, and support future policy and guidelines on school closures and the support adolescent girls need in the wake of similar future catastrophe.

从2020年3月下旬开始，肯尼亚开始了封锁，包括关闭学校。在 10月16日，上升的老年人可以回到学校准备考试。在肯尼亚西部，女孩中间 15-19岁的艾滋病毒患病率为8.8％，HSV-2患病率为28％，学校关闭可能会有深远的状态 对艾滋病毒和性传播感染（STI）风险的持久影响。在436个中学的队列中 女孩，我们正在评估月经杯对阴道微生物组（VMB），细菌阴道的影响 （BV）和Stis。 10月1日，我们开始了30个月的访问，在12月之前跟进了371（85％）的女孩 18。bv的患病率为21.8％，衣原体，淋病或毛毛虫的患病率为15.6％ 自上次访问时上次措施以来，BV增加了55％（14％），STI自上次增加34％ 在12个月的评估（11.6％）处进行测量。针对社会经济因素进行了调整，报道高价值的女孩 相关的压力和人际暴力增加了BV和STI的几率。尤其是青少年 对应激感应的影响敏感的轴敏感；压力增加和随后的皮质醇增加 导致雌激素减少，这是支持乳酸乳杆菌的主要环境所必需的 这有助于防止BV，性传播感染和艾滋病毒。这项研究提出了衡量社会经济，行为和 COVID-19危机的社会心理影响，这与女孩的性暴露有何关系，随后发生的风险 BV，STI和HIV。在AIM 1中，我们将量化Covid-19的经济，社会心理和行为影响 以及关联的锁定和限制。个人和乡村级别的评估包括食物的变化 安全，水获取，家庭收入，暴力，犯罪和安全。个人措施包括广泛的 性行为，焦虑，抑郁症状，人际暴力。在AIM 2中，我们将衡量 COVID-19与艾滋病毒和性传播感染风险的压力源的关联。我们将能够估计STI的危害和 在多种条件下的艾滋病毒结局：covid（2018年4月至2019年10月），在COVID/学校关闭期间 （自2020年3月以来），在Covid/School重新开放（预计）期间，后期（预期）。在AIM 3中，我们将 测量皮质醇和雌二醇，并将其与报告的压力相关，并量化这些压力的影响 对VMB组成以及随后的BV，STI和HIV的压力的生物学测量。了解女孩自己的 对行为和上下文变化的看法和推理，并将其应用于干预 开发，我们将采用一系列半结构化焦点小组讨论。含义：这项研究将 对Covid-19和缓解措施的财务，社会和行为影响提供详细的了解 肯尼亚西部地区为非洲粗糙地区的青春期女孩所做的努力。我们将能够 为了与生物学结果有关，VMB，BV，STI，HIV。获得的知识将直接 为干预发展做出贡献，并支持有关学校关闭的未来政策和准则 在发生类似的未来灾难之后，支持青春期女孩的需求。