Stress and HIV infection in South African adolescent girls.

南非少女的压力和艾滋病毒感染。

• 批准号: 10315914
• 负责人: Marie Stoner
• 金额: $ 19.67万
• 依托单位: RESEARCH TRIANGLE INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-01 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10315914
• 关键词: AIDS prevention; AIDS/HIV problem; Accounting; Acquired Immunodeficiency Syndrome; Acute; Address; Adherence; Adolescence; Adolescent; Adult; Affect; Africa; Africa South of the Sahara; Antibody titer measurement; Area; Behavior; Biological; Biological Markers; Biological Process; Blood; C-reactive protein; CD4 Lymphocyte Count; Caring; Childhood; Chronic; Classification; Clinical; Cohort Studies; Communicable Diseases; Crime; Cytomegalovirus; Data; Data Sources; Decision Making; Disadvantaged; Economically Deprived Population; Europe; Female Adolescents; Goals; HIV; HIV Infections; HIV Seronegativity; HIV Seropositivity; HIV prevention trials network; Health; Health Services Accessibility; Health Status; Herpesviridae; Herpesvirus 1; Immunologic Markers; Improve Access; Impulsivity; Incidence; Income; Individual; Infection; Inflammation; Intervention; Investigation; Link; Measures; Mental Depression; Mental Health; Modification; Outcome; Pathogenesis; Persons; Physiological; Population; Poverty; Predisposition; Psychosocial Stress; Recording of previous events; Research; Research Personnel; Research Priority; Risk; Risk-Taking; Sample Size; Sampling; Sex Behavior; South Africa; South African; Specimen; Spottings; Stress; Stress Tests; Substance abuse problem; Testing; Time; Trauma; United States; United States National Institutes of Health; Unsafe Sex; Violence; Viral Load result; Virus Diseases; Visit; adverse outcome; antiretroviral therapy; biological adaptation to stress; case control; cognitive development; cohort; experience; food insecurity; health disparity; high risk; immune function; improved; intimate partner violence; low and middle-income countries; perceived stress; prevent; psychosocial stressors; response; social; social determinants; social health determinants; stressor; therapy adherence; traumatic event; young woman

PROJECT SUMMARY/ABSTRACT Adolescent girls and young women (AGYW) remain at very high risk of HIV acquisition in sub-Saharan Africa and this increased risk is tied to social and interpersonal factors. Few studies in low- and middle-income countries have collected stress-responsive biomarkers to understand biological processes, such as the physiological stress response, that may underlie the increased risk of HIV infection observed among AGYW. Evidence is mounting for the association between social determinants of health and the physiological effects of stress in the United States and Europe, but it is lacking in sub-Saharan Africa. Stress has been associated with social determinants of health and with adverse outcomes in individuals with HIV; however, these studies are among adults and with small sample sizes and evidence is limited regarding incident HIV infection. The overarching objective of the proposed project is to generate preliminary evidence examining the relationships between psychosocial stressors; biological stress; and HIV prevention, care, and treatment in AGYW in South Africa. The project objective will be met through three Specific Aims: Using an existing and unique data source (HIV Prevention Trials Network 068 study) with information on psychosocial stressors, stress responsive biomarkers, and HIV incidence among a cohort of 2,533 AGYW that have been followed for 9 years in South Africa, in Aim 1 we will assess associations between acute (physical and sexual intimate partner violence, traumatic events) and chronic (food insecurity, depression, and low parental support) psychosocial stressors with stress-responsive immune biomarkers (C-reactive protein [CRP] titers, herpes simplex virus type 1 (HSV-1) titers, and cytomegalovirus (CMV)) among AGYW. We will use data from 1,517 AGYW with biomarker information available at the 2018/19 visit and will explore effect modification by HIV status and correlations with perceived stress. In Aim 2 we will conduct a case-cohort study of 849 AGYW to estimate the association between stress-responsive biomarkers during adolescence with sexual behavior and incident HIV infection at later time points. We will retrospectively test existing, stored biospecimens for cases and controls to assess these relationships. In Aim 3 we will estimate associations between stress- responsive biomarkers and antiretroviral therapy (ART) adherence and viral load among AGYW with HIV. We will use data from 164 AGYW with HIV along with information available about stress-responsive biomarkers, viral load, and ART from the 2018/19 visit. This study will provide preliminary data for an R34 application to develop and pilot an intervention mitigating the effects of physiological stress among AGYW to prevent HIV and improve access to care and treatment. The research aligns with the NIH HIV/AIDS research priority to advance cross-cutting areas of research and the Maternal and Pediatric Infectious Disease Branch (MPIDB) priority of preventing HIV in adolescents.

项目概要/摘要 撒哈拉以南非洲地区的少女和年轻女性 (AGYW) 感染艾滋病毒的风险仍然很高 这种风险的增加与社会和人际因素有关。针对低收入和中等收入群体的研究很少 各国已经收集了压力响应生物标志物来了解生物过程，例如 生理应激反应，这可能是 AGYW 中观察到的 HIV 感染风险增加的基础。 越来越多的证据表明健康的社会决定因素与生理效应之间存在关联 美国和欧洲的压力很大，但撒哈拉以南非洲却缺乏。压力已关联 与健康的社会决定因素以及艾滋病毒感染者的不良后果有关；然而，这些研究 是在成年人中，样本量较小，有关艾滋病毒感染事件的证据有限。这 拟议项目的总体目标是生成初步证据，审查 社会心理压力源之间的关系；生物应激；以及艾滋病毒预防、护理和治疗 AGYW 在南非。该项目目标将通过三个具体目标来实现： 独特的数据源（艾滋病毒预防试验网络 068 研究），包含有关心理社会压力源的信息， 追踪的 2,533 名 AGYW 人群中的应激反应生物标志物和 HIV 发病率 在南非 9 年里，在目标 1 中，我们将评估急性（身体和性亲密）之间的关联 伴侣暴力、创伤性事件）和慢性（粮食不安全、抑郁和父母支持不足） 具有压力反应性免疫生物标志物（C 反应蛋白 [CRP] 滴度、疱疹 AGYW 中的单纯病毒 1 型 (HSV-1) 滴度和巨细胞病毒 (CMV) 滴度。我们将使用 1,517 个数据 AGYW 在 2018/19 访问时提供了生物标志物信息，并将探索 HIV 的影响修改 状态以及与感知压力的相关性。在目标 2 中，我们将对 849 AGYW 进行案例队列研究，以 估计青春期压力反应生物标志物与性行为之间的关联 以及稍后时间点发生的艾滋病毒感染事件。我们将回顾性测试现有的、储存的生物样本 案例和控制来评估这些关系。在目标 3 中，我们将估计压力之间的关联 HIV 感染 AGYW 的反应性生物标志物、抗逆转录病毒治疗 (ART) 依从性和病毒载量。 我们将使用 164 AGYW 感染 HIV 的数据以及有关压力反应的可用信息 2018/19 年访视的生物标志物、病毒载量和 ART。这项研究将为 R34 提供初步数据 应用程序开发和试点减轻 AGYW 生理压力影响的干预措施 预防艾滋病毒并改善获得护理和治疗的机会。该研究与 NIH HIV/AIDS 研究一致 优先推进交叉领域的研究和母婴传染病科 (MPIDB) 预防青少年艾滋病毒的优先事项。