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

About This Grant

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.