Integrating Expedited Partner STI Therapy During PrEP Delivery for Young Women

Rationale

Rates of curable sexually transmitted infections (STIs) are on the rise, with South Africa having some of the highest STI rates globally. South Africa is also home to the highest HIV-1 incidence in the world, which peaks among young women ages 15-24 years of age. With the advent of oral pre-exposure prophylaxis (PrEP) as a highly effective strategy to prevent HIV-1 infection, South Africa and other high incidence countries are actively working to provide PrEP to key populations at highest risk for HIV-1. However, PrEP is not effective against other STIs and untreated STIs can increase susceptibility to HIV-1 infections. A 2019 WHO technical brief highlighted the importance of utilizing PrEP programs to optimize efforts to reduce STIs among those at highest risk, including adolescent girls and young women (AGYW). This proposal supports global efforts to substantially reduce STIs in key populations as part of the 2030 Sustainable Development Goals (goal 3.3) and the South African National Strategic Plan [NSP] for HIV, Tuberculosis and STIs 2017-2022 (goal #1). We aim to advance the field by implementing a multidisciplinary approach to inform point-of-care (POC) diagnostic STI screening combined with expedited partner therapy (EPT) for AGYW using PrEP for HIV-1 prevention. Our findings will provide essential knowledge for clinicians and policy makers to make improvements in STI screening and treatment that will lead to reductions in rates of persistent STIs and improvements in AGYW sexual reproductive health.

Primary Objectives

  • To estimate the incidence of STIs (Chlamydia trachomatis -CT, Neisseria gonorrhoeae - NG, and Trichomonas vaginalis - TV) among AGYW initiating PrEP who received POC STI testing plus EPT and those who received POC STI testing and declined EPT.
  • To assess the acceptability of POC STI testing plus EPT for women initiating oral PrEP and their partners who received EPT and its impact on exposure to related social harms.


Estimate the cost of implementing rapid POC diagnostic STI testing and EPT for AGYW in South Africa using PrEP compared to standard syndromic management.

Primary Endpoint/Outcome

  • Incidence of recurrent STIs among AGYW who received POC STI testing with and without EPT
  • Acceptability of POC STI testing plus EPT for women initiating oral PrEP and their partners who received EPT and its impact on exposure to related social harms
  • Cost of implementing POC STI testing plus EPT for women using PrEP


Study Design

Prospective cohort study with a qualitative component


Study Population

Sexually active, HIV‐negative AGYW, 16‐24 years old, positive for NG/CT at screening, interested in initiating PrEP, not desiring pregnancy for the duration of study participation, willing to return for quarterly study visits and with no contraindications to emtricitabine (FTC ) or Tenofovir Disoproxil Fumarate (TDF).

Investigators

Wits RHI

  • Dr. Thesla Palanee-Phillips, Principal Investigator
  • Dr. Yuthika Naidoo, Co-Investigator
  • Ms. Krishnaveni Reddy, Sub-Investigator


Sponsors/Donors

National Institutes of Health (NIH); Grant No.:1R01AI155000-01A1

Latest Update: 20 August 2021

For more about Integrating expedited partner STI therapy during PrEP delivery for young women Study please email rhicomms@wrhi.ac.za