Evaluating STI screening and antimicrobial resistance in Neisseria gonorrhoeae among PrEP users in Vietnam

评估越南 PrEP 使用者中性传播感染筛查和淋病奈瑟菌耐药性

• 批准号: 10389089
• 负责人: Jeffrey David Klausner
• 金额: $ 22.08万
• 依托单位: UNIVERSITY OF SOUTHERN CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-02-05 至 2023-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10389089
• 关键词: AIDS prevention; Affect; Anatomy; Antibiotic susceptibility; Antibiotics; Antimicrobial Resistance; Antimicrobial susceptibility; Azithromycin; Cephalosporins; Characteristics; Chlamydia trachomatis; Ciprofloxacin; Data; Development; Diagnostic; Diagnostic tests; Elements; Epidemic; Foundations; Frequencies; Future; General Population; Genes; Genetic; Genetic Markers; Genitourinary system; Genomics; Guidelines; HIV; HIV Infections; HIV risk; Health; Incidence; Individual; Infection; Knowledge; Local Government; Manuscripts; Medical; Meta-Analysis; Modeling; Multiple Anatomic Sites; Neisseria; Neisseria gonorrhoeae; Oropharyngeal; Penicillin Resistance; Phase; Predisposition; Pregnant Women; Prevalence; Publishing; Rapid screening; Reporting; Research Personnel; Resistance; Risk; Risk Factors; Sexually Transmitted Diseases; Site; Syphilis; Test Result; Testing; Training; United Nations; Universities; Vietnam; Work; World Health Organization; acceptability and feasibility; cohort; data sharing; drug-resistant gonorrhea; genome sequencing; genomic locus; global health; global health emergency; high risk men; insight; low and middle-income countries; men who have sex with men; pre-exposure prophylaxis; programs; rectal; resistant strain; routine screening; satisfaction; screening; tool; transgender women; transmission process; whole genome; willingness to pay

PROJECT ABSTRACT Men who have sex with men (MSM) are at higher risk for HIV and sexually transmitted infections (STIs) that increase HIV risk, such as Neisseria gonorrhoeae and Chlamydia trachomatis. HIV pre-exposure prophylaxis (PrEP) users—many of whom are MSM—are also at increased risk for STIs. U.S. guidelines recommend that PrEP users undergo frequent screening in multiple anatomic sites (pharyngeal, urogenital, and rectal) for asymptomatic infections. However, lower- and middle-income countries (LMICs) lack such guidelines, resulting in missed opportunities for STI screening and treatment among LMIC PrEP users. Antimicrobial resistance (AMR) in N. gonorrhoeae is an urgent global health threat and the prevalence is highest in LMICs, where access to diagnostics is limited. In particular, the Western Pacific Region, which includes the LMIC of Vietnam, has seen increasing spread of AMR in N. gonorrhoeae, which has spread worldwide. Major gaps exist in understanding the drivers of AMR in N. gonorrhoeae in LMICs. In this study, investigators from UCLA and Hanoi Medical University will investigate the acceptability and feasibility of C. trachomatis and N. gonorrhoeae screening among MSM and transwomen engaged in an HIV PrEP program in Hanoi, Vietnam. We hypothesize that screening will be acceptable and feasible. We will also investigate risk factors for AMR and genomic relationships between commensal Neisseria and N. gonorrhoeae at genetic loci associated with AMR, hypothesizing that recent antibiotic use is a risk factor for AMR. AIM 1: (a) To determine the distribution of anorectal, pharyngeal, and urogenital C. trachomatis and N. gonorrhoeae infections among MSM and transgender women PrEP users (n=1,300) in Hanoi, Vietnam and (b) To evaluate the acceptability and feasibility, including willingness to pay, of rapid, triple-site testing. AIM 2: (a) To collect, culture, and perform antibiotic susceptibility testing on N. gonorrhoeae and oropharyngeal Neisseria species to investigate the prevalence and correlates of AMR and b) To perform whole-genome sequencing on pairs of N. gonorrhoeae and Neisseria species isolated from within the same individual to investigate relationships within genes associated with antimicrobial resistance in N. gonorrhoeae. This two-year project has four phases. Phase 1 will last three months and will involve development of study materials, planning, and training. Phase 2 will last one year and will evaluate acceptability and feasibility of C. trachomatis and N. gonorrhoeae screening. Phase 3 will last 9 months and will involve antimicrobial susceptibility testing and whole genome sequencing. Phase 4 will last 3 months and will involve dissemination of findings through manuscripts, presentations, and sharing of data with local government and health agencies. Findings from the study will form the foundation for a future R01-proposal to investigate the impact of routine screening and treatment of STIs on the development of antimicrobial resistance is N. gonorrhoeae.

项目摘要 与男性发生性关系（MSM）的男性面临更高的艾滋病毒和性传播感染的风险（stis） 增加艾滋病毒的风险，例如淋病奈瑟氏菌和沙眼衣原体。艾滋病毒前暴露 预防用户（PREP）用户（其中​​许多是MSM）也有ETI的风险增加。美国准则 建议在多个解剖部位（咽，泌尿生殖器，， 无症状感染的直肠）。但是，中低收入国家（LMIC）缺乏这样的 指南，导致LMIC Prep用户之间错过了STI筛查和治疗的机会。 淋病。 在LMIC中，获得诊断的限制是最高的。特别是西太平洋地区 包括越南的LMIC，已经看到AMR在N. gonorrhoeae中的传播增加了，它已经传播了 全世界。在LMIC中，了解AMR的驱动因素中存在主要差距。 在这项研究中，UCLA和河内医科大学的研究人员将调查可接受性和 MSM和跨性别者在艾滋病毒中筛查的沙眼梭状疱疹和淋病链球菌的可行性 越南河内的准备计划。我们假设筛查将是可以接受和可行的。我们也会 研究AMR的危险因素以及共生奈瑟氏菌与淋病链球菌之间的基因组关系 在与AMR相关的遗传环境中，假设最近使用抗生素是AMR的危险因素。 AIM 1：（a）确定肛门直肠，咽和泌尿生殖的沙眼和N.的分布。 河内，越南和（b）的MSM和变性女性预备使用者（n = 1,300）的淋病感染（n = 1,300） 评估可接受性和可行性（包括愿意支付的意愿）快速，三个站点测试。 目的2：（a）在淋病和口咽上收集，培养和进行抗生素敏感性测试 奈瑟菌种类研究AMR和B）进行全基因组的患病率和相关性 对从同一个体内部分离到的淋病和奈瑟氏菌对成对进行测序 研究与淋病链球菌中与抗菌素抗性相关的基因之间的关系。 这个为期两年的项目有四个阶段。第1阶段将持续三个月，并将涉及研究 材料，计划和培训。第2阶段将持续一年，并将评估C的可接受性和可行性。 沙眼和淋病。第三阶段将持续9个月，将涉及抗菌素 敏感性测试和整个基因组测序。第4阶段将持续3个月，并将涉及传播 通过手稿，演示和与地方政府和卫生机构共享数据的发现。 该研究的发现将为未来的R01抢劫奠定基础，以调查日常工作的影响 筛查和治疗性传播感染在抗菌耐药性发展方面是淋病猪笼草。