Developing a risk assessment tool to identify HIV-uninfected adolescent girls and young women at highest risk for HIV infection: a key step for targeted biomedical HIV prevention

开发风险评估工具来识别艾滋病毒感染风险最高的未感染艾滋病毒的少女和年轻妇女：有针对性的生物医学艾滋病毒预防的关键步骤

• 批准号: 10252155
• 负责人: Nora Rosenberg
• 金额: $ 23.33万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-04-01 至 2023-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10252155
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Address; Adherence; Africa South of the Sahara; African; Age-Years; Algorithms; Area; Assessment tool; Biological Markers; Biometry; Cameroon; Characteristics; Clinical; Complex; Country; Data; Development; Emergency Situation; Epidemic; Epidemiologic Factors; Epidemiology; Ethiopia; Female; Female Adolescents; Goals; HIV; HIV Infections; HIV-infected adolescents; Health; High Risk Woman; Household; Incidence; Individual; Infant; Infection; Intervention; Intervention Studies; Ivory Coast; Kenya; Laboratories; Lasso; Lesotho; Machine Learning; Malawi; Measures; Methodology; Methods; Modeling; Namibia; Oral; Outcome; Performance; Persons; Population; Pregnancy; Prevention strategy; Principal Investigator; Receiver Operating Characteristics; Research; Research Personnel; Risk; Risk Assessment; Risk Factors; Rwanda; Sampling; Sensitivity and Specificity; Structure; Surveys; Tanzania; Techniques; Tenofovir; Testing; UNICEF; Uganda; Validation; Woman; World Health Organization; Zambia; Zimbabwe; adolescent HIV prevention; adverse outcome; age group; base; career; clinical risk; experience; high risk; high-risk adolescents; implementation science; improved; model development; multidisciplinary; population based; pre-exposure prophylaxis; predictive modeling; programs; tool; transmission process; young woman

PROJECT SUMMARY/ABSTRACT Background: In sub-Saharan Africa (SSA), adolescent girls and young women (AGYW) 15-24 years of age remain at epicenter of the HIV epidemic, with more than 270,000 new HIV infections each year. Biomedical HIV prevention strategies like tenofovir-based oral pre-exposure prophylaxis (PrEP) are promising measures for reducing HIV acquisition in AGYW. However, providing PrEP to all 100 million AGYW in SSA is not feasible, economical, or necessary, as the risk of HIV acquisition among AGYW is not uniformly high. Risk assessment tools are needed to identify those AGYW sub-populations at greatest risk for acquiring HIV in order to support targeted PrEP program implementation. Existing risk assessment tools for HIV incidence in AGYW have had important limitations surrounding feasibility, validity, and generalizability. The primary goal of this project is to develop a regional risk assessment tool for AGYW that is feasible to implement, valid, and generalizable. Our overarching premise is that risk of HIV acquisition among AGYW is not uniform and it is possible to identify high risk AGYW at a regional level. Aims and Methods: Using nationally representative data from 13 African countries collected as part of the Population-based HIV Impact Assessment (PHIA) initiative, our team will address this premise through three specific aims. In the first aim, we will explore risk factors associated with recent HIV infection, a marker of incident HIV, among AGYW. Recent infection is defined in the PHIA data using a well-established testing algorithm. Using data from 13 PHIA surveys from 2015-2019, which include >50,000 observations, individual, structural, household, and epidemiologic predictors of recent HIV infection among AGYW will be identified. In the second aim, we will use the candidate predictors from the first aim to develop and internally validate a risk assessment tool to identify AGYW at highest risk of HIV acquisition. In the third aim, we will externally validate the risk assessment tool in five second-round PHIA surveys from 2020. Team: The team, led by an early-career Principal Investigator, has expertise in HIV prevention for AGYW, biomedical HIV prevention, risk score development, and advanced methods for complex survey data. The team is supported by a technical advisory panel of experts from multiple SSA regions. Expected Impact: These findings will provide an in-depth understanding of the current transmission dynamics of HIV among AGYW in SSA. At the end of the study, we expect to have a validated clinical risk assessment tool that can be applied to a range of SSA settings. Such a tool has the potential to transform the clinical delivery of PrEP and other biomedical HIV prevention strategies in SSA.

项目摘要/摘要 背景：在撒哈拉以南非洲(SSA)，15-24岁的少女和年轻妇女 仍处于艾滋病毒流行的中心，每年新增艾滋病毒感染者超过27万人。生物医学艾滋病毒 预防策略，如基于替诺福韦的口服暴露前预防(PrEP)是有希望的措施 减少AGYW的艾滋病毒感染。然而，向SSA的所有1亿AGYW提供PrEP是不可行的， 这是经济的，也是必要的，因为AGYW感染艾滋病毒的风险并不都很高。风险评估 需要工具来确定哪些AGYW亚群感染艾滋病毒的风险最大，以便支持 有针对性地实施PrEP计划。AGYW现有的艾滋病毒发病率风险评估工具已经 围绕可行性、有效性和普适性的重要限制。这个项目的主要目标是 为AGYW开发一个可行、有效和可推广的区域风险评估工具。我们的 最重要的前提是，AGYW之间感染艾滋病毒的风险并不一致，有可能确定高风险 在区域层面上冒AGYW的风险。 目标和方法：使用从13个非洲国家收集的具有国家代表性的数据，作为 基于人口的艾滋病毒影响评估(PHIA)倡议，我们的团队将通过三个方面解决这一前提 明确的目标。在第一个目标中，我们将探索与最近感染艾滋病毒有关的风险因素，艾滋病毒感染是事件的标志 HIV，在AGYW中。最近的感染是在PHIA数据中使用完善的测试算法定义的。 使用来自2015-2019年的13项PHIA调查的数据，其中包括50,000个观察，个人，结构， 将确定AGYW中最近感染艾滋病毒的家庭和流行病学预测因素。在第二个 目标，我们将使用第一个目标中的候选预测器来开发和内部验证风险评估 确定艾滋病病毒感染风险最高的AGYW的工具。在第三个目标中，我们将从外部验证风险 从2020年开始的五次第二轮PHIA调查中的评估工具。 团队：该团队由职业生涯早期的首席调查员领导，拥有AGYW艾滋病毒预防方面的专业知识， 生物医学艾滋病毒预防，风险评分发展，以及复杂调查数据的先进方法。该队 由来自多个SSA区域的专家组成的技术咨询小组提供支持。 预期影响：这些发现将提供对当前传播动态的深入了解 在SSA的AGYW中，艾滋病毒的比例很高。在研究结束时，我们希望有一个经过验证的临床风险评估工具 这可以应用于一系列SSA设置。这样的工具有可能改变临床上提供的 SSA的PREP和其他生物医学艾滋病毒预防战略。