# Understanding STI and HIV prevention adherence among Kenyan women

> **NIH NIH K23** · UNIVERSITY OF WASHINGTON · 2020 · $187,812

## Abstract

ABSTRACT
This K23 Mentored Patient-Oriented Research Career Development Award proposal supports a 5-year research
and training program for Dr. Jenell Stewart to establish herself as an independent investigator with expertise in
sexually transmitted infection (STI) and HIV prevention. Dr. Stewart is an Infectious Diseases physician-scientist
with a strong track record of dedication to STI and HIV research in low-resource settings and extensive
experience in international collaborations. For this proposal, Dr. Stewart will benefit from additional training,
including formal course work and mentorship, in design and analysis of STI and HIV prevention trials,
assessment of sexual exposures and event-driven adherence, and mixed-methods analysis of gendered power
dynamics in adherence behavior. In the past decade, rates of bacterial STIs have increased markedly in
populations worldwide. In addition to increased risk of HIV infections, young Kenyan women have very high STI
rates with severe consequences (e.g., pelvic inflammatory disease, tubal infertility, complications of pregnancy).
Post-exposure prophylaxis (PEP) with the antibiotic doxycycline (dPEP) has been proposed as a novel STI
control strategy, and dPEP trials among men who have sex with men are ongoing with one completed and
multiple planned. This K23 proposal will leverage the first trial of dPEP among women, launching in Kenya in
January 2020. In contrast to other STI prevention strategies that rely on partner participation, on-demand dPEP
would be woman-controlled; however, little is known about adherence behavior to STI prevention among Kenyan
women. Understanding adherence to HIV pre-exposure prophylaxis (PrEP) in African women was key to
accurately defining effectiveness in this population, and similarly dPEP adherence will be important to measure
and evaluate. We hypothesize that provision of dPEP with high adherence will substantially reduce the incidence
of bacterial STIs, particularly Chlamydia trachomatis as well as Treponema pallidum and Mycoplasma
genitalium. The longitudinal evaluation of M. genitalium in women in the parent randomized trial of dPEP will
provide unique data on this emerging STI. Aim 1 will measure the effect of dPEP adherence on bacterial STI
protection by leveraging a randomized trial of dPEP versus standard risk-reduction counseling among Kenyan
women (N=446) followed for 12 months using hair drug concentrations to determine adherence in a
comprehensive case-cohort analysis. Aim 2 will assess the impact of a recent diagnosis with an STI from point-
of-care STI testing on subsequent longitudinal prevention behavior (adherence to dPEP and PrEP and frequency
of condomless sex) using self-reported behavior validated against biological measures. Aim 3 will determine how
gendered power dynamics relate to adherence behavior using a mixed methods analysis of quantitative and
qualitative measures of gendered power differentials in primary sexual relationships. This pro...

## Key facts

- **NIH application ID:** 10079962
- **Project number:** 1K23MH124466-01
- **Recipient organization:** UNIVERSITY OF WASHINGTON
- **Principal Investigator:** Jenell Stewart
- **Activity code:** K23 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $187,812
- **Award type:** 1
- **Project period:** 2020-07-01 → 2025-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10079962

## Citation

> US National Institutes of Health, RePORTER application 10079962, Understanding STI and HIV prevention adherence among Kenyan women (1K23MH124466-01). Retrieved via AI Analytics 2026-05-21 from https://api.ai-analytics.org/grant/nih/10079962. Licensed CC0.

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