PrEP among high-risk young women in South Africa: real-world barriers to use and patterns of re-initiation and PrEP cycling

南非高危年轻女性的 PrEP：现实世界的使用障碍以及重新启动和 PrEP 循环的模式

• 批准号: 10261425
• 负责人: Amrita Rao
• 金额: $ 4.07万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-16 至 2022-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10261425
• 关键词: AIDS prevention; Accounting; Adopted; Africa South of the Sahara; Age; Back; Behavioral; Calendar; Caring; Characteristics; Clinical; Clinical Trials; Continuity of Patient Care; Country; Data; Data Linkages; Development; Dropout; Economics; Effectiveness; Epidemic; Epidemiologist; Event; Fellowship; Female; Female Adolescents; Goals; HIV; HIV Infections; HIV/TB; Heterogeneity; High Risk Woman; Incidence; Individual; Infection; Infrastructure; Intervention; Knowledge; Link; Mean Survival Times; Mediation; Mentorship; Methods; Modeling; National Institute of Mental Health; Nonprofit Organizations; Partnership Practice; Pattern; Pharmacy facility; Population Dynamics; Prevalence; Process; Prophylactic treatment; Provider; Province; Records; Research; Research Personnel; Risk; Services; Site; South Africa; South African; Structure; Students; Time; Time trend; Training; Training Programs; Ursidae Family; Woman; Work; condoms; data management; discrete time; experience; falls; female sex worker; high risk; high-risk adolescents; implementation barriers; implementation science; improved; male; pre-exposure prophylaxis; prevent; programs; scale up; service delivery; service engagement; skills; time use; tool; trend; young woman

PROJECT SUMMARY Significance: HIV incidence is disproportionately high among adolescent girls and young women (AGYW) and young female sex workers (YFSW) in South Africa. PrEP has been shown to be an efficacious, female- controlled, biomedical opportunity to prevent new HIV infections. Despite the established efficacy of PrEP to prevent HIV, initiation of and retention on PrEP by women in both clinical trial and real-world settings has been poor. National scale-up of PrEP in South Africa has been challenged by the same issues seen elsewhere, including similarly low levels of initiation and retention among young women. To add to this challenge of PrEP retention, PrEP need, unlike treatment need, not only differs among individuals, but also can vary over time within individuals, depending on changing risk. To accomplish the goals of this proposal, we will build on a strong existing partnership with TB HIV Care(THC), the largest PrEP provider to young women in South Africa. Specific Aims: We aim to 1) characterize temporal trends of and individual and structural characteristics associated with PrEP initiation, among PrEP eligible YFSW and AGYW who participated in the THC program between 2016-2020, 2) assess characteristics associated with PrEP retention and examine aggregate changes over time, among YFSW and AGYW who initiated PrEP at the THC program between 2016-2020, and 3) explore patterns of re-initiation and PrEP cycling among YFSW and AGYW who initiated PrEP at the THC program between 2016-2020. Inference generated by this study will directly feed back and inform the THC program. Approach: For all three aims, we will utilize routinely collected data on over 24,000 high-risk young women served by THC, including individual service user clinical files and program logs. For Aim 1, we will quantitatively compare characteristics for those who initiated PrEP and those who did not using discrete time-to-event analysis accounting for competing risks, and model the longitudinal patterns of PrEP initiation. For Aim 2, we will examine retention on PrEP among women who initiated as part of the program, and quantitatively compare characteristics for those who are and are not retained on PrEP. We will also model patterns of PrEP retention over calendar time. For Aim 3, we will use a restricted mean survival time analysis to characterize patterns of re-initiation and PrEP cycling (women discontinuing and re-initiating), including the proportion of women who had originally initiated who are a. retained on PrEP, b. engaged in the program, but no longer on PrEP (both low and high risk), c. lost to the program, and d. HIV-infected over time. Fellowship Information: Proposed PI Rao will leverage the training program, including selected courses, tailored mentorship, and professional development, to further her knowledge, skills, and experience to complete the proposed research and become a successful academic epidemiologist, studying implementation science and the use of routine data to improve HIV services particularly for marginalized women.

项目摘要 意义：青春期女孩和年轻女性（AGYW）和 南非的年轻女性性工作者（YFSW）。预备被证明是一种有效的女性 受控的生物医学机会，以防止新的艾滋病毒感染。尽管准备已经确定 在临床试验和现实环境中，预防妇女对妇女的艾滋病毒，启动和保留率一直是 贫穷的。南非的全国Prep规模扩大受到其他地方相同的问题的挑战， 包括年轻女性的同样低水平的启动和保留率。为了增加准备挑战 保留，准备工作，与治疗不同，不仅在个人之间有所不同，而且随着时间的流逝可能会有所不同 在个人内部，取决于风险的变化。为了实现该提议的目标，我们将建立在一个基础上 与TB HIV Care（THC）的现有合作伙伴关系是南非年轻妇女最大的预科提供者。 具体目的：我们的目的是1）表征个人和结构特征的时间和结构特征 与参加PREP启动相关的YFSW和参与THC计划的AGYW 在2016 - 2020年之间，2）评估与保留相关的特征并检查骨料变化 随着时间的流逝，在2016 - 2020年之间在THC计划中启动PREP的YFSW和AGYW中，3）探索 YFSW和AGYW之间的重新启动和准备循环的模式 在2016 - 2020年之间。这项研究产生的推论将直接反馈并告知THC计划。 方法：对于所有三个目标，我们将使用24,000多名高风险年轻女性的常规收集数据 由THC服务，包括个人服务用户临床文件和程序日志。对于AIM 1，我们将定量 比较那些发起PreP的人和不使用离散时间分析的人的特征 考虑竞争风险，并建模准备启动的纵向模式。对于AIM 2，我们将检查 保留作为该计划一部分发起的女性的准备，并定量比较特征 对于那些并且没有保留的人。我们还将建模在日历上保留的预备率模式 时间。对于AIM 3，我们将使用受限制的平均生存时间分析来表征重新启动的模式和 预备骑行（女性中断和重新生产），包括最初的妇女比例 启动谁是。保留在准备上，b。从事该计划，但不再进行PREP（低风险和高风险）， c。失去了该计划，d。随着时间的推移，艾滋病毒感染。 奖学金信息：拟议的Pi Rao将利用培训计划，包括选定的课程， 量身定制的指导和专业发展，以进一步发展她的知识，技能和经验 完成拟议的研究并成为一名成功的学术流行病学家，研究实施 科学和使用常规数据改善艾滋病毒服务，尤其是针对边缘化妇女。

项目成果

A disproportionate epidemic: COVID-19 cases and deaths among essential workers in Toronto, Canada.

• DOI: 10.1016/j.annepidem.2021.07.010
• 发表时间: 2021-11
• 期刊: Annals of epidemiology
• 影响因子: 5.6
• 作者: Rao A;Ma H;Moloney G;Kwong JC;Jüni P;Sander B;Kustra R;Baral SD;Mishra S
• 通讯作者: Mishra S

Exploring the Association Between Depression and Social and Biobehavioral HIV Risk Factors Among Female Sex Workers in Nelson Mandela Bay Municipality, South Africa.

探索南非纳尔逊·曼德拉湾市女性性工作者抑郁症与社会和生物行为艾滋病毒危险因素之间的关联。

• DOI: 10.1089/aid.2020.0233
• 发表时间: 2021
• 期刊: AIDS research and human retroviruses
• 影响因子: 1.5
• 作者: Rossouw,Johannes;Schwartz,Sheree;Rao,Amrita;Mcingana,Mfezi;Young,Katherine;Hausler,Harry;Baral,Stefan
• 通讯作者: Baral,Stefan

Evaluating the quality of HIV epidemiologic evidence for populations in the absence of a reliable sampling frame: a modified quality assessment tool.

• DOI: 10.1016/j.annepidem.2021.07.009
• 发表时间: 2022-01
• 期刊: Annals of epidemiology
• 影响因子: 5.6
• 作者: Rao A;Schwartz S;Viswasam N;Rucinski K;Van Wickle K;Sabin K;Wheeler T;Zhao J;Baral S
• 通讯作者: Baral S

Persistence on oral pre-exposure prophylaxis (PrEP) among female sex workers in eThekwini, South Africa, 2016-2020.

• DOI: 10.1371/journal.pone.0265434
• 发表时间: 2022
• 期刊: PloS one
• 影响因子: 3.7
• 作者: Rao A;Mhlophe H;Comins C;Young K;Mcingana M;Lesko C;Mulumba N;Baral S;Hausler H;Schwartz S
• 通讯作者: Schwartz S

The Relationship Between the Global Burden of Influenza From 2017 to 2019 and COVID-19: Descriptive Epidemiological Assessment.

• DOI: 10.2196/24696
• 发表时间: 2021-03-02
• 期刊: JMIR public health and surveillance
• 影响因子: 8.5
• 作者: Baral SD;Rucinski KB;Twahirwa Rwema JO;Rao A;Prata Menezes N;Diouf D;Kamarulzaman A;Phaswana-Mafuya N;Mishra S
• 通讯作者: Mishra S