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.

抽象的 STIRRUP（PrEP 下的 STI 响应和建议）将大数据流与数学相结合 科学建模和经济决策科学，以了解 PrEP 护理中 STI 筛查的最佳设计。 过去十年来，淋病、衣原体和梅毒病例大幅增加，并且 部分疾病负担落在男男性行为者（MSM）身上。性传播感染发病率持续居高不下 MSM 的驱动因素是无症状感染者比例高和常规筛查率低， 会检测到这些感染。大多数使用 PrEP 的 MSM 感染性传播感染的风险较高。 PrEP 护理 因此，提供了一个重要的机会来接触和临床参与可以从中受益的人群 关联的艾滋病毒和性传播感染预防服务。按照 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危险行为增加的影响，以预防持续性 STI 传播链。然而，PrEP 护理中的性传播感染筛查模式远未得到推荐 水平，因人口统计和地理因素而存在很大差异。为临床实践和公众提供信息的模型 因此，卫生政策必须纳入涵盖 PrEP 所在医疗保健环境范围的数据流 向这些群体提供护理，并在哪些方面可以改进。长期、多疾病 PrEP 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 PrEP 护理是一种有效的方法 常规性传播感染筛查和治疗的机制，但频繁的性传播感染辅助服务往往可能是一个 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 电子健康记录中 MSM 的筛查模式和三种 PrEP 的流行病学研究 两个地理环境（波士顿和亚特兰大）的项目（学术、公立和私立）以其特点而著称 艾滋病毒/性传播感染负担和人口统计。分析将指导大数据道德框架的制定 造型。目标 2. 利用这些数据，我们将构建基于网络的四个共同种族分层传输模型 三个暴露地点（泌尿生殖系统）的 MSM 中存在循环感染（HIV、衣原体、梅毒和淋病） 塔尔、直肠和咽）。这些模型将研究 PrEP 使用与 HIV/STI 之间的关系 鉴于当前细菌性传播感染筛查/治疗（PrEP 启动前和后）的发生率，以理论为驱动 重点关注每个城市内部和内部的种族/民族差异和心理健康预测因素。目标 3. 我们将评估- 评估用于筛查和治疗性传播感染的公共卫生政策和临床实践策略 使用 PrEP 的 MSM 异质组。经济模型将评估政策的成本效益 根据临床病史进行个体化，并评估针对社会资源的最佳方法，以减少 用户自付费用可提高长期 PrEP 保留率的辅助 PrEP 服务。