Integrating expedited partner STI therapy during PrEP delivery for young women

项目总结 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 并且是口服暴露前预防(PrEP)以防止艾滋病毒-1感染的关键目标人群。此外, 寻求PrEP的AGYW经常经历可治愈的性传播感染(STI)的高比率。当前 南非PrEP指南建议对性传播感染进行综合征治疗，这意味着只有女性报告 症状将得到治疗。众所周知，综合症的管理尤其成问题。 对于女性来说，因为绝大多数可治愈的性传播感染是没有症状的。持续的、未经治疗的感染可能会导致 严重的生殖健康后果，包括盆腔炎、不孕、宫外孕、 新生儿感染和艾滋病毒-1感染风险增加。AGYW的高STI发病率呈上升趋势， 强调需要采取有效的筛查战略，以降低性传播感染的发病率及其对 性健康和生殖健康结果。在有HIV-1感染风险并有兴趣开始 PREP、看护点诊断性传播感染检测和快速伙伴治疗(EPT)是两种可能的策略 对性传播感染的发病率有重大影响。很少有研究评估EPT的可行性和可接受性 在低收入和中等收入国家，到目前为止，还没有研究评估护理点的实施情况 在PrEP扩大的背景下进行STI测试和EPT。这项提议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将于#年在南非对有资格接受PrEP的AGYW进行前瞻性队列研究 我们将评估护理点性传播感染检测加EPT的可接受性及其对发病率的影响 常见的可治愈的性传播感染超过12个月的随访(目标1和2)。我们将对以下人员进行定性采访 参与者及其男性伙伴，以确定促进者和EPT摄取的障碍(目标2)并进行 比较成本分析以估算使用和不使用护理点性传播感染检测的人均成本 EPT增加了护理标准的费用(目标3)。拟议研究的结果将提供 国家政策制定者的基本知识，以推进性传播感染筛查和治疗的方法， 导致性传播感染的减少和青年性生殖健康的改善。由此产生的数据 提案对于为实现2030年妇女减少性传播感染和艾滋病毒-1负担的努力提供信息至关重要 可持续发展目标，其中包括大幅减少关键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.