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

自二零二零年三月下旬起，为应对COVID-19，肯尼亚开始封锁，包括关闭学校。对 10月16日，高三学生可以返校准备考试。在肯尼亚西部， 15-19岁的艾滋病毒感染率为8.8%，HSV-2感染率为28%，学校关闭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组（VMB）的影响，细菌性阴道病 (BV)和STI。10月1日，我们开始了为期30个月的访问，到12月，我们随访了371名（85%）女孩 18. BV的患病率为21.8%，衣原体、淋病或滴虫的患病率为15.6%， 18个月访视时BV较上次测量增加55%（14%），STI较上次增加34% 在12个月评价时测量（11.6%）。经社会经济因素调整后，报告高COVID的女孩- 相关压力和人际暴力增加了BV和STI的几率。青少年尤其 对压力引起的对低血压轴的影响敏感;压力增加，随后皮质醇升高 导致雌激素减少，这是支持卷曲乳杆菌优势环境所必需的 帮助预防BV、STI和HIV。这项研究建议衡量社会经济，行为， COVID-19危机的心理社会影响，这与女孩的性暴露以及随后的 BV、STI和HIV。在目标1中，我们将量化COVID-19的经济、社会心理和行为影响 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。具体措施包括： 性行为焦虑抑郁症状人际暴力在目标2中，我们将测量 COVID-19压力因素与艾滋病毒和性传播感染风险的关联。我们将能够估计性病的危害， 多种情况下的艾滋病毒结果：COVID前（2018年4月至2019年10月），COVID/学校关闭期间 （自二零二零年三月起）、COVID ╱学校重开期间（预期）、COVID后（预期）。在目标3中，我们 测量皮质醇和雌二醇，并将其与报告的压力相关联，并量化这些因素的影响。 对VMB组成和随后的BV、STI和HIV的压力的生物学测量。了解女孩自己 对行为和环境变化的感知和推理，并将其应用于干预 在发展过程中，我们将采用一系列半结构化的焦点小组讨论。结论：本研究将 详细了解COVID-19对财务、社会和行为的影响以及缓解措施 肯尼亚西部的这一地区就是非洲农村地区为青春期女孩所作努力的例证。我们将能够 检查这与生物学结果的关系- VMB、BV、STI、HIV。获得的知识将直接 促进制定干预措施，并支持未来关于关闭学校和 在未来发生类似灾难后，为少女提供所需的支助。

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.