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: 10343849
• 负责人: Jeffrey David Klausner
• 金额: $ 16.19万
• 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 2024-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10343849
• 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 男男性行为者 (MSM) 感染艾滋病毒和性传播感染 (STI) 的风险较高 增加艾滋病毒风险的因素，例如淋病奈瑟菌和沙眼衣原体。 美国指南指出，预防 (PrEP) 使用者（其中许多是 MSM）感染性传播感染的风险也较高。 建议 PrEP 用户在多个解剖部位（咽、泌尿生殖、 然而，低收入和中等收入国家（LMIC）缺乏此类感染。 指南，导致中低收入国家 PrEP 用户错过性传播感染筛查和治疗的机会。 淋病奈瑟菌的抗生素耐药性 (AMR) 是一个紧迫的全球健康威胁，其患病率很高 中低收入国家的情况最为严重，因为这些国家获得诊断的机会有限，特别是西太平洋区域。 包括越南的中低收入国家，淋病奈瑟菌中的抗菌素耐药性不断增加，而淋病奈瑟菌已在其中传播 在了解中低收入国家淋病奈瑟菌抗菌素耐药性的驱动因素方面存在重大差距。 在这项研究中，加州大学洛杉矶分校和河内医科大学的研究人员将调查其可接受性和 在 MSM 和感染 HIV 的跨性别女性中进行沙眼衣原体和淋病奈瑟菌筛查的可行性 我们勇敢地说，越南河内的 PrEP 计划是可以接受和可行的。 研究共生奈瑟菌和淋病奈瑟菌之间 AMR 的危险因素和基因组关系 与 AMR 相关的基因位点，假设最近使用抗生素是 AMR 的危险因素。 目标 1：(a) 确定肛门直肠、咽部和泌尿生殖道沙眼衣原体和奈瑟菌的分布。 越南河内 MSM 和跨性别女性 PrEP 使用者 (n=1,300) 的淋病感染和 (b) 评估快速三站点测试的可接受性和可行性，包括支付意愿。 目标 2：(a) 收集、培养淋病奈瑟菌和口咽奈瑟菌并进行抗生素敏感性测试 奈瑟菌属物种，用于调查 AMR 的流行率和相关性，以及 b) 进行全基因组分析 对从同一个体内分离出的成对淋病奈瑟菌和奈瑟菌进行测序 研究与淋病奈瑟菌耐药性相关的基因内的关系。 这个为期两年的项目分为四个阶段，第一阶段将持续三个月，并将涉及研究进展。 第二阶段将持续一年，并将评估 C 的可接受性和可行性。 沙眼衣原体和淋病奈瑟菌筛查将持续 9 个月，并将涉及抗菌药物。 敏感性测试和全基因组测序将持续 3 个月，并将涉及传播。 通过手稿、演示以及与当地政府和卫生机构共享数据来了解调查结果。 该研究的结果将为未来 R01 提案奠定基础，以调查日常活动的影响 对淋病奈瑟菌耐药性发展的性传播感染进行筛查和治疗。