Leveraging Public Health Infrastructures to Support Sexual Health for Women Living in the Southern United States – Frontiers

 

Study Overview and Alignment with Sustainable Development Goals (SDGs)

This report outlines the study protocol for the Camellia Cohort, a single-arm longitudinal study designed to advance HIV prevention among women in Alabama. The project’s framework is intrinsically linked to several United Nations Sustainable Development Goals (SDGs), primarily focusing on improving health outcomes, promoting equality, and reducing systemic disparities.

• SDG 3: Good Health and Well-being: The study directly addresses Target 3.3 by aiming to end the HIV epidemic through enhanced prevention, testing, and linkage to care.
• SDG 5: Gender Equality: By focusing exclusively on the health needs of cisgender and transgender women, the study seeks to empower a vulnerable demographic and address gender-specific barriers to healthcare.
• SDG 10: Reduced Inequalities: The research is situated in Alabama, a high-priority state within the U.S. Ending the HIV Epidemic (EHE) strategy, thereby targeting a region with significant health disparities.
• SDG 17: Partnerships for the Goals: The project is founded on a multi-sectoral collaboration between academic, public health, and private institutions.

Core Objectives and Contribution to SDG 3 (Good Health and Well-being)

Primary Aims

The Camellia Cohort is designed to integrate epidemiological methods with mHealth technology to achieve specific public health objectives. The primary goals are to:

• Characterize HIV transmission dynamics among women in an EHE focus state.
• Assess engagement in the HIV prevention care cascade, including the use of pre-exposure prophylaxis (PrEP).
• Determine the incidence of HIV and other sexually transmitted infections (STIs).
• Identify key predictors, mediators, and moderators influencing prevention behaviors and health outcomes.

Strategic Approach to Public Health

The study’s methodology is designed to advance SDG 3 by making healthcare more accessible and responsive. A home-based HIV and STI testing program allows for the delivery of tailored sexual health information, testing, and linkage to care remotely. This “light-touch” cohort design, facilitated by an mHealth app, is a modern approach to public health research that reduces barriers to participation and provides critical data on STI and HIV incidence in a high-priority population.

Methodology and Technological Integration

Participant Recruitment and Cohort Design

The study employs a single-arm longitudinal cohort design. In partnership with the Alabama Department of Public Health, the recruitment strategy targets a population with clear indications for enhanced prevention services, thereby contributing to SDG 10 (Reduced Inequalities).

• Target Population: Cisgender and transgender women aged 18-50 residing in Alabama.
• Recruitment Source: A state database of women recently diagnosed with gonorrhea or syphilis.
• Enrollment Method: Potential participants are contacted via telephone for recruitment into the digital cohort.

Data Collection Process

Participants are followed for a minimum of 24 months, with data collected through a combination of remote technologies and traditional methods. The process is as follows:

1. Participants are enrolled in the digital Camellia Cohort and gain access to a refined mHealth app platform.
2. Every six months, participants complete home-based HIV and STI testing.
3. Participants complete online surveys concurrently with the home-based testing.
4. Data on PrEP use and other outcomes are collected via self-report, medical record review, and analysis of dried blood spots.

Addressing Inequalities and Promoting Gender Equality

Focus on Gender Equality (SDG 5)

The study’s exclusive focus on cisgender and transgender women is a direct effort to address gender-based disparities in HIV prevention and care. By investigating the specific factors that influence health behaviors in this population, the research aims to generate insights that can inform more effective, gender-responsive health strategies. The use of a Community Advisory Board to refine the mHealth app ensures the intervention is acceptable and relevant to the women it is designed to serve.

Reducing Health Disparities (SDG 10)

The Camellia Cohort actively works to reduce health inequalities by concentrating its efforts in a region and on a demographic disproportionately affected by HIV and STIs. By recruiting women with a recent STI diagnosis, the study targets individuals with demonstrated vulnerability and provides them with access to prevention tools, testing, and support, directly contributing to the goal of reducing health outcome disparities.

Expected Outcomes and Collaborative Impact (SDG 17)

Primary Outcomes and Indicators

The study is expected to yield critical insights into the feasibility and acceptability of remote, technology-driven public health interventions. Key outcomes include:

• Data on HIV and STI incidence.
• Information on PrEP uptake and adherence.
• Identification of predictors, mediators, and moderators for HIV/STI acquisition and prevention behaviors.

Partnerships for the Goals (SDG 17)

This research exemplifies a powerful multi-stakeholder partnership, uniting the expertise of:

• Academic Institutions: University of Alabama at Birmingham, Florida State University.
• Government Bodies: Alabama Department of Public Health.
• Private Sector: Target RWE (data science).

This collaboration is essential for leveraging diverse resources and knowledge to tackle the complex challenge of ending the HIV epidemic.

Conclusion

The Camellia Cohort study represents a significant advancement in public health research. By combining mHealth technology, data science, and proven epidemiological methods, it is poised to provide vital data on HIV prevention among women in a high-priority region. The findings will not only inform regional health strategies but also contribute to the global achievement of SDGs 3, 5, and 10 by promoting health, equality, and well-being for a vulnerable population.

1. Which SDGs are addressed or connected to the issues highlighted in the article?

SDG 3: Good Health and Well-being

• The article’s primary focus is on public health, specifically addressing the prevention and transmission of HIV and other sexually transmitted infections (STIs). The study protocol is designed to “offer tailored sexual health information, testing, linkage to care and support while assessing STI and HIV incidence.” This directly contributes to ensuring healthy lives and promoting well-being.

SDG 5: Gender Equality

• The study specifically targets “cis- and transwomen in Alabama,” a demographic that faces unique vulnerabilities and disparities in health outcomes, particularly concerning HIV and STIs. By developing an mHealth app platform for this group and aiming to understand “prevention behaviors among women,” the research promotes the health, empowerment, and well-being of women.

SDG 10: Reduced Inequalities

• The research is set in “Alabama, one of seven states prioritized in the federal Ending the HIV Epidemic (EHE) strategy,” indicating a focus on a region with significant health disparities. By targeting women in this “high-priority region” who were “recently diagnosed with gonorrhea or syphilis,” the study aims to reduce inequalities in health outcomes and access to care for a vulnerable population.

SDG 17: Partnerships for the Goals

• The article highlights a multi-stakeholder collaboration essential for the study’s execution. It mentions a partnership between academic institutions (University of Alabama at Birmingham, Florida State University), a government agency (“Alabama Department of Health”), a private entity (“Target RWE”), and civil society (“Community Advisory Board”). This collaboration exemplifies the spirit of partnership to achieve development goals.

2. What specific targets under those SDGs can be identified based on the article’s content?

SDG 3: Good Health and Well-being

• Target 3.3: By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases. The study’s goal to understand “HIV transmission dynamics” and reduce “STI and HIV incidence” in a prioritized EHE state directly aligns with the aim of ending the AIDS epidemic.
• Target 3.7: By 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education… The study provides “home-based HIV and sexually transmitted infection (STI) testing,” “tailored sexual health information,” and “linkage to care,” which are all core components of sexual health-care services.

SDG 5: Gender Equality

• Target 5.6: Ensure universal access to sexual and reproductive health and reproductive rights… The focus on providing women with tools and information for “HIV and STI testing,” understanding “prevention behaviors,” and promoting “PrEP use” empowers them to manage their sexual and reproductive health.
• Target 5.b: Enhance the use of enabling technology, in particular information and communications technology, to promote the empowerment of women. The study’s use of an “mHealth app platform” and “home-based” testing leverages technology to deliver health services and information directly to women, thereby empowering them.

SDG 10: Reduced Inequalities

• Target 10.2: By 2030, empower and promote the social, economic and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion or economic or other status. The project focuses on empowering a specific, vulnerable population (“cis- and transwomen in Alabama” with recent STI diagnoses) by improving their access to health information and care, thereby promoting their inclusion in health systems.

SDG 17: Partnerships for the Goals

• Target 17.17: Encourage and promote effective public, public-private and civil society partnerships… The article explicitly describes such a partnership, involving the University of Alabama, the Alabama Department of Public Health, Target RWE, and a Community Advisory Board to achieve its public health objectives.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

Indicators for SDG 3

• HIV and STI incidence: The article explicitly states that one of the “Primary outcomes” is to assess “HIV and STI incidence.” This directly measures progress towards Target 3.3 and is a key health indicator.
• Pre-exposure prophylaxis (PrEP) use: The study measures “PrEP use via self-report, medical record review, and dried blood spots.” PrEP uptake is a critical indicator of access to and use of modern HIV prevention methods, relevant to Targets 3.3 and 3.7.
• Engagement in the prevention care cascade: The conclusion mentions studying “engagement in the prevention care cascade among women.” This can be measured by tracking rates of testing, linkage to care, and adherence to prevention methods, serving as a composite indicator for access to healthcare services (Target 3.7).

Indicators for SDG 5

• Feasibility and acceptability of a remote, light-touch cohort design: The study aims to provide insights into the “feasibility and acceptability” of its mHealth approach. Data on app usage, participant retention, and satisfaction would serve as indicators for the successful use of technology to empower women with health information (Target 5.b).

Indicators for SDG 10

• Predictors for HIV and STI incidence among a specific population: By identifying “predictors, mediators and moderators for HIV and STI incidence” among women in a high-priority region, the study provides data that can be used to measure and understand the specific health inequalities faced by this group, informing actions to reduce those inequalities (Target 10.2).

4. Table of SDGs, Targets, and Indicators

SDGs	Targets	Indicators Identified in the Article
SDG 3: Good Health and Well-being	3.3: End the epidemics of AIDS and other communicable diseases. 3.7: Ensure universal access to sexual and reproductive health-care services.	HIV and STI incidence rates. Rate of PrEP use. Rates of engagement in the prevention care cascade (testing, linkage to care).
SDG 5: Gender Equality	5.6: Ensure universal access to sexual and reproductive health. 5.b: Enhance the use of enabling technology to promote the empowerment of women.	Feasibility and acceptability of the mHealth app among women. Uptake of sexual health services (testing, information) by women in the cohort.
SDG 10: Reduced Inequalities	10.2: Empower and promote the inclusion of all.	Identification of predictors for HIV/STI incidence in a high-priority, vulnerable population. Data on access to care for women in a geographically prioritized EHE state.
SDG 17: Partnerships for the Goals	17.17: Encourage and promote effective public, public-private and civil society partnerships.	The existence of the described partnership itself (University, Dept. of Health, Target RWE, Community Advisory Board).

Source: frontiersin.org