The changing face of HIV in the era of COVID-19: Maximising HIV incidence reduction through dynamic targeting of current and future distributions of acquisition risk.

COVID-19 时代艾滋病毒的面貌不断变化：通过动态定位当前和未来的感染风险分布，最大限度地降低艾滋病毒发病率。

• 批准号: 10548290
• 负责人: Henry Godwell Mwambi
• 金额: $ 51.72万
• 依托单位: STELLENBOSCH UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-03-01 至 2027-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10548290
• 关键词: AIDS prevention; Africa; Africa South of the Sahara; Age; Area; Attitude; Autopsy; Biological; Biological Markers; Blood; COVID-19; COVID-19 pandemic; Cause of Death; Cessation of life; Clinic; Clinical; Clinical Data; Communities; Country; Data; Dryness; Early identification; Effectiveness; Elements; Epidemic; Epidemiologic Methods; Epidemiology; Event; Evolution; Exposure to; Funding; Future; General Population; Goals; HIV; HIV Infections; HIV risk; HIV/AIDS; Health; Health Services; Household; Human immunodeficiency virus test; Incidence; Individual; Infection; Infrastructure; Intervention; Knowledge; Life Cycle Stages; Link; Measures; Modality; National Institute of Child Health and Human Development; Paper; Pattern; Persons; Pharmaceutical Preparations; Population; Prevalence; Prevention; Prevention program; Prevention strategy; Public Sector; Records; Regimen; Research; Research Institute; Residencies; Resolution; Risk; Risk Reduction; Rural; Rural Community; Schools; Sex Behavior; South Africa; South African; Spottings; Statistical Methods; Subgroup; Target Populations; Testing; Time; Treatment Protocols; United States National Institutes of Health; Variant; Viral Load result; Viremia; Vulnerable Populations; Work; age group; antiretroviral therapy; care delivery; cohort; cost effective; design; future implementation; genomic data; human old age (65+); indexing; intervention program; longitudinal analysis; mortality; next generation; novel; peri-urban; population based; population health; pre-exposure prophylaxis; preventive intervention; response; rural South Africa; scale up; sex; sociodemographics; success; surveillance data; transmission process; treatment adherence; treatment program; urban area; verbal; AIDS prevention; Africa; Africa South of the Sahara; Age; Area; Attitude; Autopsy; Biological; Biological Markers; Blood; COVID-19; COVID-19 pandemic; Cause of Death; Cessation of life; Clinic; Clinical; Clinical Data; Communities; Country; Data; Dryness; Early identification; Effectiveness; Elements; Epidemic; Epidemiologic Methods; Epidemiology; Event; Evolution; Exposure to; Funding; Future; General Population; Goals; HIV; HIV Infections; HIV risk; HIV/AIDS; Health; Health Services; Household; Human immunodeficiency virus test; Incidence; Individual; Infection; Infrastructure; Intervention; Knowledge; Life Cycle Stages; Link; Measures; Modality; National Institute of Child Health and Human Development; Paper; Pattern; Persons; Pharmaceutical Preparations; Population; Prevalence; Prevention; Prevention program; Prevention strategy; Public Sector; Records; Regimen; Research; Research Institute; Residencies; Resolution; Risk; Risk Reduction; Rural; Rural Community; Schools; Sex Behavior; South Africa; South African; Spottings; Statistical Methods; Subgroup; Target Populations; Testing; Time; Treatment Protocols; United States National Institutes of Health; Variant; Viral Load result; Viremia; Vulnerable Populations; Work; age group; antiretroviral therapy; care delivery; cohort; cost effective; design; future implementation; genomic data; human old age (65+); indexing; intervention program; longitudinal analysis; mortality; next generation; novel; peri-urban; population based; population health; pre-exposure prophylaxis; preventive intervention; response; rural South Africa; scale up; sex; sociodemographics; success; surveillance data; transmission process; treatment adherence; treatment program; urban area; verbal

Project Summary South Africa has the largest HIV epidemic worldwide with 7.8 million people currently living with HIV. The scaling up of HIV treatment and prevention over the past decade has led to a reduction of nearly half of new HIV infections and AIDS related deaths between 2010 and 2020. Notwithstanding this success, our team has presented evidence showing that reduction in new infections is not homogeneous over time and space and across the age-sex strata. This uneven risk reduction has led to a shift in the HIV risk landscape resulting in the emergence of new vulnerable groups. Two major events are likely to cause further changes to the risk landscape. The first is the shift to Dolutegravir-based antiretroviral treatment regimens. The second is the disruptions of health services caused by the COVID-19 pandemic creating unprecedented challenges in HIV care delivery. Our long-term goal for this proposal is to design the next-generation HIV combination prevention strategies for poor rural communities in sub-Saharan Africa, which will maximize HIV incidence reduction through identification and targeting of the most vulnerable sub-groups. We envisage that early identification of emergent vulnerable subpopulations would become a key element for an effective programmatic response. Our project will take advantage of one of the largest ongoing population-based HIV cohorts in the world – the Africa Health Research Institute’s population cohort in rural KwaZulu-Natal, with individual-level sociodemographic, biological, and clinical data as well as comprehensive genomics data in the fully integrated individual data platform. The project will leverage the institute’s existing infrastructure and high-resolution data to (i) Quantify the shifts in the spatial, temporal and demographic burden of new HIV infections (2022-2026); and (ii) Harness the changes in the dynamics of the HIV epidemic to design future intervention programs which will maximize HIV incidence reduction based on the dynamic needs of the most vulnerable sub-populations.

项目摘要 南非在世界范围内拥有最大的艾滋病毒流行病，目前有780万人 艾滋病病毒。过去十年来扩大艾滋病毒治疗和预防的扩展导致了减少 在2010年至2020年之间，几乎一半的新艾滋病毒感染和与艾滋病有关的死亡。 尽管取得了成功，但我们的团队已经提供了证据表明，新的 随着时间和空间以及整个年龄性地层的感染并不是均匀的。这个不平坦 降低风险已导致艾滋病毒风险景观的转变，导致新的出现 脆弱的群体。两个重大事件可能会导致风险格局的进一步变化。 首先是向基于Dolutegravir的抗逆转录病毒治疗方案的转变。第二个是 由19009年大流行造成的卫生服务中断创造了前所未有的 艾滋病毒护理的挑战。 该提案的长期目标是设计下一代HIV组合预防 撒哈拉以南非洲贫困农村社区的策略，这将最大化艾滋病毒事件 通过识别和靶向最脆弱的子组来减少。我们设想 早期对紧急脆弱亚群的识别将成为 有效的程序响应。我们的项目将利用正在进行的最大的 基于人群的艾滋病毒队列 - 非洲卫生研究所的人口 在粗糙的夸祖鲁 - 纳塔尔族中的队列，具有个人水平的社会人口统计学，生物学和临床数据 以及完全集成的个人数据平台中的全面基因组学数据。这 项目将利用研究所现有的基础架构和高分辨率数据来量化 新艾滋病毒感染的空间，临时和人口伯恩的变化（2022-2026）； （ii）利用艾滋病毒动力学的变化设计未来的干预 根据最大的动态需求，将最大化HIV事件减少的程序 脆弱的子人群。