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（STI Responses and Recommendations Under PrEP）结合了大数据流和数据分析， 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。 淋病、衣原体和梅毒的病例在过去十年中大幅增加， 男性同性性行为者（MSM）承担了福尔斯的前列腺疾病负担。性传播感染率居高不下， 无症状感染的高比例和常规筛查的低比例是导致MSM的原因， 能检测出这些感染大多数使用PrEP的MSM患性病的风险都很高。PrEP护理 因此，提供了一个关键的机会，以达到和临床参与的人群谁可以受益于 将艾滋病毒和性传播感染预防服务联系起来。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风险行为增加的影响， STI传播链。然而，在PrEP护理中进行STI筛查的模式远未得到推荐 人口统计学和地理学差异很大。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的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。在一个扩展的，多疾病的PrEP 连续护理，包括STI辅助服务和PrEP保留的步骤，我们寻求测试领先的 关于这两个步骤的双向性的假设：正在进行的全面PrEP护理是一种有效的 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可能往往是 负担保留在PrEP护理. STIRRUP包括三个具体目标：目标1。我们会提取，收集， 分析和综合有关PrEP护理、性行为、心理健康诊断和艾滋病毒/性传播感染的信息 从电子健康记录和流行病学研究中筛查MSM的模式 计划（学术，公共和私人）在两个地理环境（波士顿和亚特兰大）区分他们的 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， 建模AIM 2.有了这些数据，我们将建立基于网络的种族分层传输模型的四个合作， 男男性接触者在三个接触点（泌尿生殖道， 谈话、直肠和咽）。这些模型将调查PrEP使用与HIV/STI之间的关系 考虑到当前细菌性STI筛查/治疗（PrEP启动前后）的发生率， 重点关注每个城市之间和内部的种族/民族差异和心理健康预测因素。AIM 3.我们会评估- 评估公共卫生政策和临床实践战略，以筛查和治疗 经济模型将估计政策的成本效益 个性化的临床病史，并评估最佳方法，以针对社会资源，以减少 辅助PrEP服务的自付用户成本，可以改善PrEP的长期保留。