PrEP among high-risk young women in South Africa: real-world barriers to use and patterns of re-initiation and PrEP cycling

项目总结 意义：青春期女孩和年轻妇女中艾滋病毒发病率高得不成比例(AGYW)和 南非的年轻女性性工作者。普雷普已经被证明是一位有效的女性- 有控制的生物医学机会，以防止新的艾滋病毒感染。尽管PrEP对以下方面的疗效已经确立 预防艾滋病毒，在临床试验和现实世界环境中由妇女启动和保留PrEP 可怜。在南非扩大PrEP的国家规模受到了其他地方看到的相同问题的挑战， 包括年轻女性的入会和保留率也同样很低。要增加PrEP的这一挑战 保留，PrEP需要，与治疗需要不同，不仅因人而异，而且可能会随着时间的推移而变化 在个人内部，取决于不断变化的风险。为了实现这项提案的目标，我们将建立在 与南非最大的为年轻女性提供PrEP的结核病艾滋病毒护理(THC)建立了牢固的现有合作伙伴关系。 具体目标：我们的目标是：1)表征时间趋势以及个人和结构特征 与PrEP启动相关，在符合PrEP资格的YFSW和AGYW中参与THC计划 2016-2020年间，2)评估与PrEP保留相关的特征并检查总体变化 随着时间的推移，在2016-2020年间在THC计划中发起PrEP的YFSW和AGYW中，3)探索 在THC计划中发起PrEP的YFSW和AGYW之间的重新启动和PrEP循环的模式 2016-2020年间。这项研究产生的推理将直接反馈并通知THC程序。 方法：对于所有这三个目标，我们将利用常规收集的超过24,000名高危年轻女性的数据 由THC提供服务，包括个人服务用户临床文件和程序日志。对于目标1，我们将在数量上 比较启动PrEP和未使用离散事件间隔时间分析的人的特征 考虑竞争风险，并对PrEP启动的纵向模式进行建模。对于目标2，我们将检查 作为计划的一部分，女性对PrEP的保留，并定量比较特征 对于那些在PrEP上被保留和没有被保留的人。我们还将对PrEP在日历上的保留模式进行建模 时间到了。对于目标3，我们将使用受限的平均生存时间分析来表征重新启动和 准备骑自行车(妇女停止和重新开始)，包括最初 A.保留在PrEP上，B.参与该计划，但不再接受PrEP(低风险和高风险)， C.输给了这个项目，D.随着时间的推移感染了艾滋病毒。 奖学金信息：建议的皮劳将利用培训计划，包括精选的课程， 量身定做的指导和专业发展，以促进她的知识、技能和经验，以 完成建议的研究，成为一名成功的学术流行病学家，研究实施 科学和利用常规数据改善艾滋病毒服务，特别是对边缘化妇女的服务。

PROJECT SUMMARY Significance: HIV incidence is disproportionately high among adolescent girls and young women (AGYW) and young female sex workers (YFSW) in South Africa. PrEP has been shown to be an efficacious, female- controlled, biomedical opportunity to prevent new HIV infections. Despite the established efficacy of PrEP to prevent HIV, initiation of and retention on PrEP by women in both clinical trial and real-world settings has been poor. National scale-up of PrEP in South Africa has been challenged by the same issues seen elsewhere, including similarly low levels of initiation and retention among young women. To add to this challenge of PrEP retention, PrEP need, unlike treatment need, not only differs among individuals, but also can vary over time within individuals, depending on changing risk. To accomplish the goals of this proposal, we will build on a strong existing partnership with TB HIV Care(THC), the largest PrEP provider to young women in South Africa. Specific Aims: We aim to 1) characterize temporal trends of and individual and structural characteristics associated with PrEP initiation, among PrEP eligible YFSW and AGYW who participated in the THC program between 2016-2020, 2) assess characteristics associated with PrEP retention and examine aggregate changes over time, among YFSW and AGYW who initiated PrEP at the THC program between 2016-2020, and 3) explore patterns of re-initiation and PrEP cycling among YFSW and AGYW who initiated PrEP at the THC program between 2016-2020. Inference generated by this study will directly feed back and inform the THC program. Approach: For all three aims, we will utilize routinely collected data on over 24,000 high-risk young women served by THC, including individual service user clinical files and program logs. For Aim 1, we will quantitatively compare characteristics for those who initiated PrEP and those who did not using discrete time-to-event analysis accounting for competing risks, and model the longitudinal patterns of PrEP initiation. For Aim 2, we will examine retention on PrEP among women who initiated as part of the program, and quantitatively compare characteristics for those who are and are not retained on PrEP. We will also model patterns of PrEP retention over calendar time. For Aim 3, we will use a restricted mean survival time analysis to characterize patterns of re-initiation and PrEP cycling (women discontinuing and re-initiating), including the proportion of women who had originally initiated who are a. retained on PrEP, b. engaged in the program, but no longer on PrEP (both low and high risk), c. lost to the program, and d. HIV-infected over time. Fellowship Information: Proposed PI Rao will leverage the training program, including selected courses, tailored mentorship, and professional development, to further her knowledge, skills, and experience to complete the proposed research and become a successful academic epidemiologist, studying implementation science and the use of routine data to improve HIV services particularly for marginalized women.