Alignment of PrEP use with HIV risk in young women

摘要 口服暴露前预防（PrEP）是世界卫生组织推荐的艾滋病毒预防组合的组成部分。 在许多国家，这是一种经批准的生物医学干预措施。在撒哈拉以南非洲， 妇女是艾滋病毒预防的优先人群，鉴于最近艾滋病毒感染率很高， 妇女艾滋病毒感染率和迫切需要不需要男性参与的战略 伙伴该领域的一个关键问题是，启动PrEP的年轻女性是否有持续的艾滋病毒风险， 坚持充分的PrEP，当他们与艾滋病毒发生无避孕套性行为时， 被感染的伴侣这项建议的主要目标是利用现有的年轻妇女群体， 在乌干达开展接触前预防（PrEP），对艾滋病毒风险进行客观测量， 妇女使用PrEP是否与她们感染艾滋病毒的真实风险相一致。为了实现我们的目标，我们将收集 样本并进行实验室检测，以确定我们正在进行的队列中的女性是否具有：1）可检测的 Y染色体DNA（表明在过去一周内暴露于精液）和/或2）感染常见的可治愈的 细菌性性传播感染淋球菌或C.沙眼，无论是艾滋病毒风险的迹象。我们 还将开始招募和跟踪作为妇女性伴侣的年轻男子， 年轻人是否感染了N.淋球菌C.沙眼或艾滋病毒。我们将使用新的方法， 招募年轻男子，包括通过其女性伴侣提供艾滋病毒自我检测包。这些新措施 艾滋病毒风险的数据将与已经收集的血液和每日药盒中替诺福韦浓度的数据合并 开放，PrEP使用的客观措施。 我们指定了以下目标：1）确定年轻女性对PrEP的坚持是否符合 使用PrEP依从性和艾滋病毒风险的客观措施评估艾滋病毒风险; 2）确定年轻女性是否 坚持PrEP与其男性伴侣的艾滋病毒状况和风险相一致。 冲击对艾滋病毒风险的客观衡量和年轻女性男性伴侣的参与是唯一的 了解女性感染艾滋病风险的真正途径。我们的研究将提供一个框架，以了解如何以及何时 年轻女性决定采取PrEP，估计受益于艾滋病毒保护的女性比例 当他们有男性伴侣感染艾滋病毒或有感染艾滋病毒的高风险时， 年轻男子在PrEP交付和妇女的PrEP使用的支持者。

ABSTRACT Oral pre-exposure prophylaxis (PrEP) is a recommended component of combination HIV prevention by the World Health Organization and an approved biomedical intervention in many countries. In sub-Saharan Africa, young women are a priority population for HIV prevention and targeted to initiate PrEP, given the recent high rates of HIV incidence among women and urgent needs for strategies that do not require the engagement of male partners. A key question in the field is whether young women initiating PrEP have ongoing HIV risk and adhere to PrEP sufficiently to have protection from HIV when they have condomless sex with HIV- infected partners. The primary objective of this proposal is to leverage an existing cohort of young women using pre-exposure prophylaxis (PrEP) in Uganda to conduct objective measurement of HIV risk and determine whether women’s use of PrEP aligns with their true risk for acquiring HIV. To achieve our aims, we will collect samples and conduct laboratory assays to determine whether women in our ongoing cohort have: 1) detectable Y chromosome DNA (indicating exposure to semen in the past week) and/or 2) infection with common curable bacterial sexually transmitted infections N. gonorrhoeae or C. trachomatis, either are indications of HIV risk. We will also initiate recruitment and follow up of young men who are sexual partners of the women to determine whether the young men are infected with N. gonorrhoeae, C. trachomatis or HIV. We will use novel methods to recruit young men including the provision of HIV self-test kits through their female partners. These new measures of HIV risk will be merged with already collected data on tenofovir concentration in blood and daily pill box openings, objective measures of PrEP use. We have specified the following aims: 1) To determine whether young women’s adherence to PrEP aligns with HIV risk using objective measures of PrEP adherence and HIV risk and 2) To determine whether young women’s adherence to PrEP aligns with the HIV status and risk of their male partners. Impact. Objective measurement of HIV risk and the engagement of young women’s male partners is the only true way to know the HIV risk of women. Our study will provide a framework for understanding how and when young women decide to take PrEP, estimate the proportion of women that are benefitting from HIV protection when they have male partners with or at high risk of acquiring HIV, and provide novel opportunity to engage young men in PrEP delivery and as supporters of women’s PrEP use.