Risk factors for genital inflammation among women at high risk of HIV in Uganda: a mixed-method, longitudinal analysis

乌干达艾滋病毒高危女性生殖器炎症的危险因素：混合方法纵向分析

• 批准号: MR/R023182/1
• 负责人: Tara Beattie
• 金额: $ 101.78万
• 依托单位: London School of Hygiene & Tropical Medicine
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2019
• 资助国家: 英国
• 起止时间: 2019 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FR023182%2F1
• 关键词: Risk; factors; genital; inflammation; among

Globally, HIV/AIDS remains a huge problem, with 37 million people living with HIV/AIDS. Two-thirds of these live in sub-Saharan Africa, where women and girls are more likely to be infected than men and boys. Recent research shows that a woman who has inflammation in her reproductive tract (vagina and cervix) is more likely to acquire HIV infection than a woman without inflammation. However, we do not yet understand the reasons why some women have this inflammation, while others do not. So far, HIV research has focused on reproductive tract physiology and immunology, but recent studies suggest that experiencing violence or heavy alcohol use may increase genital inflammation. This study will bring together these fields of research. It will ask: What are the physical causes of genital inflammation? And which behaviours put us at risk? To answer these questions, we will conduct a study with Ugandan women at high risk of HIV infection who are already enrolled in a long-term cohort study called The Good Health for Women Project (GHWP). Approximately half of these women will have experienced physical or sexual violence in the previous six months, approximately half are problem drinkers, and approximately 45% are living with HIV. The research project will run for three years. We will enrol the first 750 HIV uninfected women who attend the clinic from October 2018 and who consent to participate in the study. Women will complete a behavioural-biological survey when they enrol in the study (baseline), and again at a follow-up visit, 6-12 months later. We will ask 25 of these women to also participate in two qualitative interviews, conducted close to baseline and 6-12 months later. The GHWP currently asks women in the cohort to complete a questionnaire each time they visit the clinic, about their age, income, where they live, sexual behaviour, recent alcohol and drug use, and hormonal contraception use. For our study, we will ask additional questions: Have they have ever experienced physical, sexual or emotional violence and who the perpetrator was? Do they have symptoms of a mental health illness (such as depression, anxiety or PTSD)? Are they feeling suicidal? What are their vaginal washing and cleaning practices? The research team will provide a dedicated counselling service and will offer referrals to the service at each interview. At each clinic visit, we already offer rapid HIV testing and testing for other infections for women who have symptoms. In addition, at the two study visits we will ask women to provide a tube of blood (to test for HSV-2, syphilis, and inflammation in the blood), a urine sample (to test for schistosomiasis infection) and 4 genital swabs (to test for gonorrhoea, chlamydia, trichomonas vaginalis and bacterial vaginalis). We will also ask women to wear a menstrual cup (like a diaphragm) for two minutes to collect genital fluid, which we will use to test for genital inflammation. When we have collected all the data, we will use statistical analyses to answer the following questions: 1. Which behavioural and biological factors cause genital inflammation and how do they cause it? 2. Does genital inflammation remain stable in women or does it change over time?3. What does the violence landscape look like for women in this population? What kind of violence do they experience, how frequently and who are the perpetrators? 4. How many women have a mental health illness? 5. How many women have genital inflammation?We will use the findings to design interventions to address women's multiple needs. These might include clinical (e.g. anti-inflammatories), behavioural (e.g. alcohol prevention) and empowerment (e.g. violence prevention) components, to complement existing HIV services.

在全球范围内，艾滋病毒/艾滋病仍然是一个巨大的问题，有3 700万人感染艾滋病毒/艾滋病。其中三分之二生活在撒哈拉以南非洲，那里的妇女和女孩比男子和男孩更有可能被感染。最近的研究表明，生殖道（阴道和子宫颈）有炎症的妇女比没有炎症的妇女更容易感染艾滋病毒。然而，我们还不明白为什么有些女性有这种炎症，而其他人没有。到目前为止，艾滋病毒研究主要集中在生殖道生理学和免疫学上，但最近的研究表明，经历暴力或大量饮酒可能会增加生殖器炎症。这项研究将把这些研究领域结合起来。它会问：生殖器炎症的物理原因是什么？哪些行为会给我们带来风险？为了回答这些问题，我们将对已经参加了一项名为“妇女健康项目”（GHWP）的长期队列研究的艾滋病毒感染高危乌干达妇女进行一项研究。这些妇女中约有一半在过去六个月内经历过身体暴力或性暴力，约一半是酗酒者，约45%是艾滋病毒感染者。该研究项目将持续三年。我们将招募2018年10月开始到诊所就诊并同意参加研究的前750名未感染艾滋病毒的女性。女性将在参加研究（基线）时完成行为-生物学调查，并在6-12个月后的随访中再次完成。我们将要求其中25名妇女参加两次定性访谈，分别在接近基线和6-12个月后进行。GHWP目前要求队列中的妇女在每次访问诊所时填写一份问卷，了解她们的年龄，收入，居住地，性行为，最近的酒精和药物使用以及激素避孕药的使用。在我们的研究中，我们将提出额外的问题：他们是否曾经经历过身体，性或情感暴力以及肇事者是谁？他们是否有心理健康疾病（例如抑郁症、焦虑症或创伤后应激障碍）的症状？他们有自杀倾向吗？他们的阴道清洗和清洁方法是什么？研究小组将提供专门的咨询服务，并在每次面谈时提供转介服务。在每次诊所就诊时，我们已经为有症状的妇女提供快速艾滋病毒检测和其他感染检测。此外，在两次研究访视时，我们将要求女性提供一管血液（检测HSV-2、梅毒和血液中的炎症）、一份尿液样本（检测血吸虫病感染）和4份生殖器拭子（检测淋病、衣原体、阴道毛滴虫和细菌性阴道炎）。我们还将要求女性佩戴月经杯（如隔膜）两分钟以收集生殖器液体，我们将使用这些液体来测试生殖器炎症。当我们收集了所有的数据，我们将使用统计分析来回答以下问题：1。哪些行为和生物因素会导致生殖器炎症，它们是如何引起的？2.生殖器炎症在女性中保持稳定还是随着时间的推移而变化？3.在这一人群中，妇女的暴力情况如何？他们经历了什么样的暴力，多久一次，谁是施暴者？4.有多少女性患有精神疾病？5.有多少女性患有生殖器炎症？我们将利用调查结果设计干预措施，以满足妇女的多种需求。这些可能包括临床（如抗炎药）、行为（如预防酗酒）和赋权（如预防暴力）组成部分，以补充现有的艾滋病毒服务。

项目成果

Prevalence and correlates of common mental health problems and recent suicidal thoughts and behaviours among female sex workers in Nairobi, Kenya.

• DOI: 10.1186/s12888-021-03515-5
• 发表时间: 2021-10-14
• 期刊: BMC psychiatry
• 影响因子: 4.4
• 作者: Beksinska A;Jama Z;Kabuti R;Kungu M;Babu H;Nyariki E;Shah P;Maisha Fiti Study Champions;Nyabuto C;Okumu M;Mahero A;Ngurukiri P;Irungu E;Adhiambo W;Muthoga P;Kaul R;Seeley J;Beattie TS;Weiss HA;Kimani J
• 通讯作者: Kimani J

Longitudinal experiences and risk factors for common mental health problems and suicidal behaviours among female sex workers in Nairobi, Kenya.

• DOI: 10.1017/gmh.2022.44
• 发表时间: 2022
• 期刊: CAMBRIDGE PRISMS-GLOBAL MENTAL HEALTH
• 作者: Beksinska, Alicja;Shah, Pooja;Kungu, Mary;Kabuti, Rhoda;Babu, Hellen;Jama, Zaina;Panneh, Mamtuti;Nyariki, Emily;Nyabuto, Chrispo;Okumu, Monica;Ngurukiri, Pauline;Irungu, Erastus;Kaul, Rupert;Seeley, Janet;Gafos, Mitzy;Beattie, Tara S.;Weiss, Helen A.;Kimani, Joshua
• 通讯作者: Kimani, Joshua

Alcohol Use and Associated Risk Factors Among Female Sex Workers in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

• DOI: 10.1192/bjo.2023.179
• 发表时间: 2023-07-07
• 期刊: BJPSYCH OPEN
• 影响因子: 5.4
• 作者: Beksinska, Alicja;Karlsen, Oda;Gafos, Mitzy;Beattie, Tara
• 通讯作者: Beattie, Tara

Alcohol use and associated risk factors among female sex workers in low- and middle-income countries: A systematic review and meta-analysis.

• DOI: 10.1371/journal.pgph.0001216
• 发表时间: 2023
• 期刊: PLOS global public health

Harmful Alcohol and Drug Use Is Associated with Syndemic Risk Factors among Female Sex Workers in Nairobi, Kenya.

• DOI: 10.3390/ijerph19127294
• 发表时间: 2022-06-14
• 期刊: INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH
• 作者: Beksinska, Alicja;Nyariki, Emily;Kabuti, Rhoda;Kungu, Mary;Babu, Hellen;Shah, Pooja;Nyabuto, Chrispo;Okumu, Monica;Mahero, Anne;Ngurukiri, Pauline;Jama, Zaina;Irungu, Erastus;Adhiambo, Wendy;Muthoga, Peter;Kaul, Rupert;Seeley, Janet;Weiss, Helen A.;Kimani, Joshua;Beattie, Tara S.
• 通讯作者: Beattie, Tara S.