Increased risk of STI and HIV among adolescent girls and young women due to COVID-19 and pandemic mitigation: Biological, behavioral, and psychosocial mediators

从2020年3月下旬开始，作为对新冠肺炎的回应，肯尼亚开始封锁，包括关闭学校。在……上面 10月16日，高年级学生可以回到学校准备考试。在肯尼亚西部，那里的女孩 15-19岁的艾滋病毒感染率为8.8%，HSV-2感染率为28%，学校停课可能会产生深远的影响 对艾滋病毒和性传播感染(STI)风险的持久影响。在436所中学的队列中 女孩们，我们正在评估月经杯对阴道微生物群(VMB)和细菌性阴道病的影响 (BV)和性传播疾病。10月1日，我们开始了为期30个月的访问，到12月为止，我们已经跟踪了371名女孩(85%) 18.BV的患病率为21.8%，衣原体、淋病或滴虫的患病率为15.6%，这意味着 在18个月的访问中，自上次测量以来BV增加了55%(14%)，自上次访问以来STI增加了34% 在12个月的评估中衡量(11.6%)。经社会经济因素调整后，报告高COVID的女孩- 相关的压力和人际暴力增加了BV和STI的几率。青少年尤其是 对应激引起的垂体轴的影响敏感；应激增加，随后皮质醇升高 导致雌激素减少，这是支持皱纹乳杆菌优势环境所必需的 这有助于预防BV、性传播感染和艾滋病毒。这项研究建议测量社会经济、行为和 新冠肺炎危机的心理社会影响，这与女孩的性接触有何关系，以及随后的风险 BV、STI和HIV。在目标1中，我们将量化新冠肺炎对经济、心理社会和行为的影响 以及相关的封锁和限制。个人和村庄一级的评估包括食物的变化 安全、供水、家庭收入、暴力、犯罪和安全。个别措施包括广泛的 性行为，焦虑，抑郁症状，人际暴力。在目标2中，我们将测量 新冠肺炎应激源对艾滋病毒和性传播感染风险的影响。我们将能够估计性传播感染和 多种情况下的艾滋病毒结局：COVID前(2018年4月至2019年10月)，COVID/学校关闭期间 (自2020年3月以来)，在COVID/学校重新开学期间(预期)、COVID之后(预期)。在《目标3》中，我们将 测量皮质醇和雌二醇，并将其与报告的压力相关，并量化它们的影响 对VMB成分以及随后的BV、STI和HIV压力的生物学测量。去了解女孩自己的 对行为和背景变化的感知和推理，并将其应用于干预 为了促进发展，我们将采用一系列半结构化的焦点小组讨论。影响：这项研究将 详细了解新冠肺炎的财务、社会和行为影响及缓解措施 在非洲农村地区为少女所做的努力，肯尼亚西部的这一地区就是例证。我们将能够 检查这与生物学结果--VMB、BV、STI、HIV的关系。所获得的知识将直接 促进干预措施的发展，并支持未来关于学校关闭和 在类似的未来灾难之后，青春期女孩需要的支持。

From late March 2020, in response to COVID-19, Kenya began a lockdown including shuttering schools. On 16th October, rising seniors could return to school to prepare for exams. In western Kenya, where among girls aged 15-19 HIV prevalence is 8.8% and HSV-2 prevalence is 28%, school closures likely have profound and lasting effects on HIV and sexually transmitted infection (STI) risk. Within a cohort of 436 secondary school girls, we are evaluating the effect of menstrual cups on the vaginal microbiome (VMB), Bacterial vaginosis (BV), and STIs. On October 1, we initiated the 30-month visit, having followed up 371 (85%) girls by December 18. The prevalence of BV was 21.8%, and 15.6% for chlamydia, gonorrhea, or trichomonas, representing a 55% increase in BV since last measure at the 18-month visit (14%), and 34% increase in STI since last measure at the 12-month evaluation (11.6%). Adjusted for socioeconomic factors, girls reporting high COVID- related stress and interpersonal violence had increased odds of BV and STI. Adolescents are especially sensitive to stress induced effects on the hypopituitary axis; increased stress and subsequent rise in cortisol leads to reduced estrogen, which is necessary to support the Lactobacillus crispatus dominant environment that helps prevent BV, STIs, and HIV. This study proposes to measure the socioeconomic, behavioral, and psychosocial impact of the COVID-19 crisis, how this relates to girls’ sexual exposures, and subsequent risk of BV, STI, and HIV. In Aim 1, we will quantify the economic, psychosocial, and behavioral impacts of COVID-19 and associated lockdowns and restrictions. Individual and village level assessments include changes in food security, water access, household income, violence, crime, and safety. Individual measures include extensive sexual practices, anxiety, depressive symptoms, interpersonal violence. In Aim 2, we will measure the association of COVID-19 stressors on risk for HIV and STIs. We will be able to estimate the hazard of STI and HIV outcomes under multiple conditions: pre-COVID (April 2018-October 2019), during COVID/school closures (since March 2020), during COVID/school reopening (anticipated), post-COVID (anticipated). In Aim 3, we will measure cortisol and estradiol and correlate this to reported stress, and quantify the influence of these biological measures of stress on VMB composition and subsequent BV, STI, and HIV. To understand girls’ own perceptions of and reasoning for behavioral and contextual changes, and to apply this to intervention development, we will employ a series of semi-structured focus group discussions. Implications: This study will provide detailed understanding of the financial, social, and behavioral impacts of COVID-19 and mitigation efforts on adolescent girls in rural areas of Africa as exemplified by this area of western Kenya. We will be able to examine this in relation to biological outcomes – VMB, BV, STI, HIV. The knowledge gained will directly contribute to intervention development, and support future policy and guidelines on school closures and the support adolescent girls need in the wake of similar future catastrophe.