Screening strategies for sexually transmitted infections in a high HIV incidence setting in South Africa

南非艾滋病毒高发地区的性传播感染筛查策略

• 批准号: 10761853
• 负责人: Jana Jarolimova
• 金额: $ 19.76万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2028-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10761853
• 关键词: AIDS prevention; Address; Adolescent and Young Adult; Adoption; Affect; Africa; Africa South of the Sahara; African; Biometry; Biostatistical Methods; Caring; Chlamydia; Clinic; Clinical; Clinical Investigator; Clinical Trials; Clinical Trials Design; Cohort Studies; Collaborations; Communicable Diseases; Communities; Country; Data; Diagnostic; Diagnostic tests; Effectiveness; Enrollment; Epidemiology; Etiology; Evaluation; Face; Foundations; Funding; Future; Goals; Gonorrhea; Guidelines; HIV; HIV Infections; HIV/TB; Health; Health Services; Heterogeneity; Home; Human immunodeficiency virus test; Incidence; Income; Individual; Infrastructure; Interview; K-Series Research Career Programs; Left; Location; Measures; Mentors; Mentorship; Methods; Modeling; Morbidity - disease rate; Motivation; NIH Office of AIDS Research; Nurses; Parents; Participant; Pelvic Inflammatory Disease; Persons; Physicians; Play; Population; Practical Robust Implementation and Sustainability Model; Pregnancy Complications; Prevalence; Process Measure; Provider; Qualitative Methods; Qualitative Research; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Recommendation; Reproductive Health; Research; Research Infrastructure; Research Institute; Research Methodology; Research Personnel; Research Priority; Risk; Role; STI prevention; Sample Size; Sampling; Self Care; Sensitivity and Specificity; Sexual Health; Sexually Transmitted Diseases; South Africa; Specimen; Symptoms; Testing; Time; Training; Trichomonas Infections; United States National Institutes of Health; Woman; Work; accurate diagnostics; behavior change; career; clinical epidemiology; co-infection; design; didactic education; effectiveness evaluation; experimental study; future implementation; high risk; home test; implementation determinants; implementation evaluation; implementation research; implementation science; improved; infection management; interest; low and middle-income countries; men; multidisciplinary; novel; pathogen; peer; point of care testing; pre-exposure prophylaxis; preference; primary outcome; rapid testing; rural South Africa; sample collection; scale up; screening; screening program; sexual health intervention; skills; standard of care; structural determinants; transmission process; tubal infertility; uptake; young woman

PROJECT SUMMARY Curable sexually transmitted infections (STIs) are highly prevalent among adolescents and young adults in sub-Saharan Africa, who are also at the highest risk of acquiring HIV. Untreated STIs, such as gonorrhea, chlamydia, and trichomoniasis, increase HIV acquisition and transmission risks and can lead to significant morbidity for women, including pelvic inflammatory disease, tubal infertility, and pregnancy complications. Faced by constraints in diagnostic capacity, many countries rely on syndromic management, which has poor sensitivity and specificity, particularly because the majority of curable STIs are asymptomatic. As accurate diagnostic tests for STIs are developed, effective screening strategies to reach populations at high risk for STIs and HIV, such as adolescents and young adults in rural South Africa, need to be rigorously evaluated to inform the future implementation of STI screening programs. I am an Infectious Disease physician with a background in clinical epidemiology and an interest in decreasing the burden of STIs and their contribution to HIV transmission in sub-Saharan Africa. I am motivated to pursue training to apply new methods to the design and evaluation of STI screening strategies in rural South Africa. The NIH K23 Mentored Research Career Development Award will afford me the opportunity to gain the necessary skills to become an independent clinician investigator. I will pursue training in (1) qualitative research methods, (2) discrete choice analysis and clinical trial design, and (3) implementation science methods and frameworks. I have designed a didactic curriculum to address each of these training aims and assembled a multidisciplinary mentorship team. My primary mentor is Dr. Ingrid Bassett, an expert in cohort studies and implementation research to evaluate HIV and tuberculosis linkage to care in South Africa. My mentorship team additionally includes experts in community-based, peer-led interventions for sexual health and HIV prevention in South Africa (Dr. Maryam Shahmanesh), qualitative research (Dr. Christina Psaros), and biostatistics (Dr. Robert Parker). With their guidance, I will assess young people’s preferences for STI screening and design and evaluate a community- based STI screening strategy in rural South Africa through the following specific aims: 1) Evaluate motivation and preferences for STI screening among adolescents and young adults using qualitative methods, 2) Conduct a Discrete Choice Experiment to quantify young people’s preferences for community-based STI screening, and 3) Evaluate the implementation of a new community-based STI screening strategy among adolescents and young adults. I will deepen an existing collaboration with the Africa Health Research Institute (AHRI), leveraging the infrastructure of a funded clinical trial. The proposed training and research aims will inform future efforts to expand STI screening in South Africa, and will provide a strong foundation for my career as an independent clinician investigator focused at the intersection of STIs and HIV prevention.

项目摘要 可治愈的性传播感染在非洲的青少年和年轻人中非常普遍， 撒哈拉以南非洲的妇女也是感染艾滋病毒风险最高的群体。未经治疗的性传播感染，如淋病， 衣原体和滴虫病，增加艾滋病毒感染和传播的风险，并可能导致显着的 妇女的发病率，包括盆腔炎、输卵管不孕症和妊娠并发症。 由于诊断能力有限，许多国家依赖症状管理， 敏感性和特异性，特别是因为大多数可治愈的STI是无症状的。一样准确 制定了性传播感染的诊断测试，有效的筛查战略，以覆盖性传播感染高危人群 和艾滋病毒，如南非农村的青少年和年轻人，需要进行严格的评估， 未来实施性传播感染筛查计划。我是一名传染病医生， 在临床流行病学和减少性传播感染的负担及其对艾滋病毒的贡献的兴趣 在撒哈拉以南非洲地区传播。我积极追求培训，将新方法应用于设计， 对南非农村地区性传播感染筛查战略的评估。NIH K23指导研究生涯 发展奖将使我有机会获得必要的技能，成为一个独立的 临床研究者。我将继续学习（1）定性研究方法，（2）离散选择分析， 临床试验设计;（3）实施科学方法和框架。我设计了一套教学法 课程，以解决这些培训目标的每一个，并组建了一个多学科的辅导小组。我 主要导师是Ingrid Bassett博士，他是队列研究和评估艾滋病毒实施研究的专家 和结核病的联系。我的导师团队还包括以下方面的专家： 在南非，以社区为基础、同伴为主导的性健康和艾滋病毒预防干预措施（Maryam博士 Shahmanesh）、定性研究（Christina Psaros博士）和生物统计学（Robert帕克博士）。与他们的 在指导下，我将评估年轻人对性传播感染筛查的偏好，并设计和评估一个社区- 通过以下具体目标，在南非农村实施基于性传播感染筛查战略：1）评估动机 使用定性方法在青少年和年轻人中进行性传播感染筛查， 一项离散选择实验，以量化年轻人对社区性传播感染筛查的偏好，以及 3)评估在青少年中实施新的基于社区的性传播感染筛查战略的情况， 年轻人我将深化与非洲卫生研究所的现有合作， 利用一个受资助的临床试验的基础设施。拟议的培训和研究目标将为 未来的努力，以扩大性病筛查在南非，并将提供一个强大的基础，我的职业生涯作为一个 独立的临床研究者，专注于性病和艾滋病毒预防的交叉点。