STI Response and Recommendations Under PrEP (STIRRUP)

PrEP (STIRRUP) 下的性传播感染应对和建议

• 批准号: 10555335
• 负责人: Samuel Jenness
• 金额: $ 59.47万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-02-01 至 2026-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10555335
• 关键词: AIDS prevention; Acceleration; Accounting; Address; African American; Behavioral; Big Data; Black race; Boston; Caring; Chlamydia; Cities; Clinical; Continuity of Patient Care; Data; Detection; Development; Diagnosis; Disease; Economic Models; Economics; Electronic Health Record; Epidemic; Epidemiology; Ethics; Ethnic Origin; Etiology; Genitourinary system; Geography; Goals; Gonorrhea; Guidelines; HIV; Health Policy; Heterogeneity; Incidence; Infection; Intervention; Link; Mental Health; Modeling; Modernization; Network-based; Pattern; Pharyngeal structure; Policies; Population; Prevention; Privatization; Public Health; Race; Recommendation; Recording of previous events; Rectum; Resources; Risk; STI prevention; Science; Services; Sex Behavior; Sexually Transmitted Diseases; Shapes; Site; Swab; Syphilis; Testing; Uncertainty; United States; Unsafe Sex; Variant; Visit; black men who have sex with men; burden of illness; clinical practice; condoms; cost; cost effectiveness; cost estimate; data integration; data streams; demographics; design; disparity reduction; epidemiology study; ethnic disparity; falls; geographic difference; health care settings; high risk men; improved; infection burden; infection rate; mathematical model; men; men who have sex with men; men' s group; pre-exposure prophylaxis; prevent; prevention service; programs; racial disparity; rectal; response; routine screening; scale up; screening; sexual risk behavior; success; theories; transmission process

ABSTRACT STIRRUP (STI Responses and Recommendations Under PrEP) combines big data streams with mathemat- ical modeling and economic decision science to understand the optimal design of STI screening in PrEP care. Cases of gonorrhea, chlamydia, and syphilis have increased substantially over the past decade and a dispro- portionate disease burden falls on men who have sex with men (MSM). The persistently high STI rates among MSM are driven by the high proportion of asymptomatic infections and low rates of routine screening that would detect these infections. Most MSM who use PrEP are at elevated risk of acquiring STIs. PrEP care therefore provides a critical opportunity to reach and clinically engage a population who could benefit from linked HIV and STI prevention services. Screening for STIs in PrEP care following CDC recommendations can counterbalance the effects of increases in sexual risk behavior by treating asymptomatic STIs to prevent ongo- ing STI transmission chains. However, patterns of STI screening in PrEP care are far from recommended levels, with substantial variation by demographics and geography. Models informing clinical practice and public health policy must therefore incorporate data streams that span the range of healthcare settings where PrEP care is offered to these groups, and where it can be improved. Following an Extended, Multi-Disease PrEP Continuum of Care that includes steps for STI ancillary services and PrEP retention, we seek to test a leading hypothesis about the bidirectionality of these two steps: that ongoing comprehensive PrEP care is an efficient mechanism for routine STI screening and treatment, but that frequent STI ancillary services may often be a burden to retention in PrEP care. STIRRUP includes three SPECIFIC AIMS: AIM 1. We will extract, collect, analyze, and synthesize information on PrEP care, sexual behavior, mental health diagnoses, and HIV/STI screening patterns for MSM from electronic health records and epidemiological studies in three types of PrEP programs (academic, public, and private) in two geographic settings (Boston and Atlanta) distinguished by their HIV/STI burden and demographics. Analyses will guide development of an ethical framework for big data in modeling. AIM 2. With these data, we will build network-based race-stratified transmission models of four co- circulating infections (HIV, chlamydia, syphilis, and gonorrhea) among MSM at three exposure sites (urogeni- tal, rectal, and pharyngeal). These models will investigate the relationship between PrEP use and HIV/STI incidence given current bacterial STI screening/treatment (pre- and post-PrEP initiation), with a theory-driven focus on racial/ethnic disparities and mental health predictors across and within each city. AIM 3. We will eval- uate public health policies and clinical practice strategies for screening and treatment of STIs among heterogenous groups of MSM using PrEP. Economic models will estimate the cost-effectiveness of policies individualized to clinical histories, and evaluate the optimal approach to targeting societal resources to reduce out-of-pocket user costs for ancillary PrEP services that could improve long-term PrEP retention.

摘要 Stirrup(PrEP下的STI响应和建议)将大数据流与数学- 临床模型和经济决策科学，以了解在PrEP护理中STI筛查的最佳设计。 在过去的十年里，淋病、衣原体和梅毒的病例大幅增加，一种有害的 部分疾病负担落在男男性行为者(MSM)身上。性病感染率居高不下 MSM的驱动因素是无症状感染的高比例和常规筛查的低比率 会检测到这些感染。大多数使用PrEP的男男性接触者获得性传播感染的风险较高。预科护理 因此提供了一个接触和临床接触人群的关键机会，这些人群可以受益于 联系艾滋病毒和性传播感染预防服务。根据CDC的建议，在PrEP护理中筛查性传播感染可以 通过治疗无症状性传播感染来抵消性行为风险增加的影响，以预防性行为 ING STI传输链。然而，在PrEP护理中进行STI筛查的模式远不被推荐 水平，在人口统计和地理上有很大的差异。为临床实践和公众提供信息的模式 因此，健康策略必须包含跨PrEP的医疗保健设置范围的数据流 向这些群体提供护理，并在哪里可以改进。在延长的、多疾病的PrEP之后 连续护理，包括STI辅助服务和PrEP保留步骤，我们寻求测试领先的 关于这两个步骤的双向性的假设：持续的全面的PrEP护理是有效的 常规性传播感染筛查和治疗机制，但频繁的性传播感染辅助服务往往是一种 保留PrEP护理的负担。Stirrup包括三个具体目标：目标1.我们将提取、收集、 分析和综合有关PrEP护理、性行为、心理健康诊断和HIV/STI的信息 MSM电子病历筛查模式及三种PrEP流行病学研究 两个地理环境(波士顿和亚特兰大)的课程(学术、公共和私立) 艾滋病毒/性传播感染的负担和人口结构。分析将指导制定大数据伦理框架 模特儿。目的2.利用这些数据，我们将建立基于网络的四个共同的种族分层传输模型 男男性接触者在三个暴露地点(泌尿生殖道感染、衣原体感染、梅毒和淋病)之间的循环感染(HIV、衣原体、梅毒和淋病)。 TAL、直肠和咽部)。这些模型将调查PrEP的使用和HIV/STI之间的关系 根据当前细菌性传播感染筛查/治疗(PrEP开始前和后)的发病率，以理论为导向 重点关注种族/民族差异和每个城市内部的心理健康预测因素。目标3.我们将评估- 评估筛查和治疗性传播感染的公共卫生政策和临床实践战略 使用PrEP的MSM异种组。经济模型将估计政策的成本效益 根据临床病史个性化，并评估以社会资源为目标的最佳方法，以减少 可提高长期PrEP保留率的辅助PrEP服务的自付用户成本。