Integrating expedited partner STI therapy during PrEP delivery for young women

项目摘要 南非的少女和年轻妇女（AGYW）是全球艾滋病毒-1发病率最高的国家之一 并且是预防HIV-1感染的口服暴露前预防（PrEP）的关键目标人群。此外，本发明还提供了一种方法， 寻求PrEP的AGYW经常遇到可治愈的性传播感染（STI）的高比率。电流 南非PrEP指南建议对性传播感染进行综合征管理，这意味着只有报告 症状将得到治疗。众所周知，综合征的管理特别成问题 因为绝大多数可治愈的性传播感染是无症状的。持续的、未经治疗的感染可能导致 严重的生殖健康后果，包括盆腔炎、不孕症、宫外孕， 新生儿感染和增加艾滋病毒-1感染的风险。青少年妇女的性传播感染发病率很高，而且呈上升趋势， 强调需要有效的筛查策略，以降低性传播感染率及其对 性健康和生殖健康成果。在有感染艾滋病毒-1风险并有兴趣开始 PrEP、床旁诊断性STI检测和快速伴侣治疗（EPT）是两种可以 对性传播感染发病率有重大影响。很少有研究评价EPT的可行性和可接受性 在低收入和中等收入国家，迄今为止，没有研究评估了床旁护理的实施情况 在扩大PrEP的背景下进行STI测试和EPT。该提案建立在近十年的合作基础上， 艾滋病毒/性传播感染预防研究，对南非有资格获得PrEP的AGYW进行前瞻性队列研究， 我们将评估床旁STI检测加EPT的可接受性及其对 在12个月的随访中，对常见的可治愈性传播感染进行评估（目标1和2）。我们将进行定性访谈， 参加者及其男性伙伴，以确定促进者和障碍，以EPT吸收（目标2），并进行了一次 比较成本分析，以估计使用床旁STI检测（有和无）进行检测的人均成本 EPT增加了标准治疗的成本（目标3）。拟议研究的结果将提供 为国家决策者提供必要的知识，以推进性传播感染筛查和治疗方法， 减少性传播感染，改善青年女青年的性生殖健康。由此产生的数据 建议是至关重要的，为减少妇女性传播感染和艾滋病毒-1的负担，实现2030年 可持续发展目标，其中包括大幅减少主要高危人群中的艾滋病毒和性传播感染。

PROJECT SUMMARY Adolescent girls and young women (AGYW) in South Africa have one of the highest HIV-1 incidences globally and are a key target population for oral pre-exposure prophylaxis (PrEP) to prevent HIV-1 acquisition. In addition, AGYW seeking PrEP frequently experience high rates of curable sexually transmitted infections (STIs). Current South African PrEP guidelines recommend syndromic management for STIs, meaning that only women reporting symptoms will receive treatment. It is well-established that syndromic management is particularly problematic for women as the vast majority of curable STIs are asymptomatic. Persistent, untreated infections can lead to serious reproductive health outcomes, including pelvic inflammatory disease, infertility, ectopic pregnancy, neonatal infections, and increased risk HIV-1 acquisition. The high STI incidence in AGYW, which is on the rise, emphasizes the need for effective screening strategies to reduce rates of STIs and their associated impact on sexual and reproductive health outcomes. Among women who are at risk for HIV-1 and interested in initiating PrEP, point-of-care diagnostic STI testing and expedited partner therapy (EPT) are two strategies that could have a substantial impact on STI incidence. Few studies have evaluated the feasibility and acceptability of EPT in low and middle-income countries and, to date, no studies have assessed the implementation of point-of-care STI testing and EPT in the context of PrEP scale-up. This proposal builds on nearly a decade of collaborative HIV/STI prevention research to conduct a prospective cohort study of AGYW eligible for PrEP in South Africa in which we will assess the acceptability of point-of-care STI testing plus EPT and its impact on the incidence of common curable STIs over 12 months of follow-up (Aims 1 and 2). We will undertake qualitative interviews with participants and their male partners to identify facilitators and barriers to EPT uptake (Aim 2) and conduct a comparative cost analysis to estimate the cost per person tested using point-of-care STI testing with and without EPT incremental to the cost of standard of care (Aim 3). Findings from the proposed research will provide essential knowledge for national policy makers to advance approaches to STI screening and treatment that will lead to reductions in STIs and improvements in AGYW sexual reproductive health. The data generated from this proposal are essential to inform efforts to reduce the burden of STIs and HIV-1 in women achieve the 2030 Sustainable Development Goals, which includes substantial reductions in HIV and STIs in key at-risk populations.