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

项目总结 可治愈的性传播感染(STI)在#年的青少年和年轻人中高度流行。 撒哈拉以南非洲，他们感染艾滋病毒的风险也是最高的。未经治疗的性传播疾病，如淋病， 衣原体和滴虫病会增加艾滋病毒的获取和传播风险，并可能导致显著的 妇女发病率，包括盆腔炎、输卵管性不孕和妊娠并发症。 面对诊断能力的限制，许多国家依赖于综合症管理，这一点很差。 敏感性和特异性，特别是因为大多数可治愈的性传播感染是无症状的。同样准确 性传播感染的诊断测试是一种有效的筛查策略，可以接触到性传播感染的高危人群 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，以告知 未来实施性传播感染筛查计划。我是一名传染病内科医生，有 临床流行病学，对减少性传播感染的负担及其对艾滋病毒的贡献感兴趣 在撒哈拉以南非洲的传播。我有动力接受培训，将新方法应用到设计和设计中 南非农村性传播感染筛查策略评估。NIH K23指导的研究生涯 发展奖将让我有机会获得必要的技能，成为一个独立的 临床医生调查员。我将继续接受(1)定性研究方法，(2)离散选择分析和 临床试验设计；(3)实施科学方法和框架。我设计了一套说教 课程，以满足每个培训目标，并组建了一个多学科指导小组。我的 主要导师是英格丽德·巴西特博士，他是评估艾滋病毒的队列研究和实施研究方面的专家 以及南非的结核病与护理的联系。我的指导团队还包括以下专家 南非以社区为基础、同行带头的性健康和艾滋病毒预防干预措施(Maryam博士 沙赫马内什)、定性研究(克里斯蒂娜·普萨罗斯博士)和生物统计学(罗伯特·帕克博士)。带着他们的 指导，我将评估年轻人对性传播感染筛查和设计的偏好，并评估一个社区- 基于南非农村的性传播感染筛查策略，具体目标如下：1)评估动机 使用定性方法对青少年和年轻人进行性传播感染筛查的偏好，2)进行 一项离散选择实验，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以社区为基础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(AHRI)现有的合作， 利用资助的临床试验的基础设施。拟议的培训和研究目标将提供信息 未来在南非扩大性病筛查的努力，将为我的职业生涯提供坚实的基础 独立临床医生调查员，专注于性传播感染和艾滋病毒预防的交叉点。

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.