HIV case finding and genetic transmission networks among MSM in Tijuana, Mexico

墨西哥蒂华纳 MSM 中的艾滋病毒病例发现和遗传传播网络

• 批准号: 8882384
• 负责人: Thomas L. Patterson
• 金额: $ 60.63万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-07-01 至 2019-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8882384
• 关键词: AIDS/HIV problem; Accounting; Acquired Immunodeficiency Syndrome; Address; Affect; California; Caring; Centers for Disease Control and Prevention (U.S.); Cities; Clinical; Contact Tracing; Country; Critical Care; Data; Disease; Drug usage; Effectiveness; Funding; General Population; Genetic; Genotype; Goals; HIV; HIV Seropositivity; Health; Home environment; Income; Individual; Infection; Link; Location; Maps; Medical; Methods; Mexico; Mission; Molecular Analysis; Names; Network-based; Newly Diagnosed; Outcome; Participant; Patient Self-Report; Patients; Persons; Pilot Projects; Population; Prevalence; Prevention strategy; Productivity; Public Health; Publishing; Recruitment Activity; Relative (related person); Reporting; Research; Sampling; Sexual Transmission; Source; Structure; Transportation; United States National Institutes of Health; Unsafe Sex; Viral; Viral Load result; base; case finding; compare effectiveness; cost; cost effectiveness; follow-up; genetic analysis; health organization; high risk; innovation; member; men; men who have sex with men; prevent; primary outcome; psychosocial; screening; sex; social norm; social stigma; transmission process; trend; virus genetics

DESCRIPTION (provided by applicant): The goal of this project is to compare the effectiveness of two methods (partner contact tracing [PCT] versus venue-based [VB] recruitment) for identifying previously undiagnosed HIV+ cases among men who have sex with men (MSM) in Tijuana, Mexico. We will also use self-reported sexual networks, high-risk venue-based networks, and viral genetic networks (inferred by analysis of viral pol sequences) to identify missing connections (e.g., anonymous partners) in sexual transmission networks. In our MSM pilot data, HIV prevalence was 20.2%, and 88% of those were unaware of their HIV+ serostatus. Identifying previously undiagnosed HIV+ persons and linking and retaining them in care are critical steps in the treatment cascade, particularly among MSM in Mexico, who are disproportionately affected by HIV. No published studies have examined case finding methods in combination with genotyping to infer sexual transmission networks. Three innovative aims will be addressed: Aim 1. Compare the effectiveness of PCT versus screening attendees of high-risk venues (e.g., sex clubs) as methods for finding previously undiagnosed HIV+ cases among MSM in Tijuana. Aim 2. Determine the extent to which sexual contact networks generated through PCT versus VB sexual networks (generated through data on MSMs' affiliations in high-risk venues) map onto viral genetic networks at baseline and one-year follow-up. Aim 3. Examine PCT versus VB case finding methods and their relationships to (a) linkage to and retention in HIV care and their psychosocial and environmental determinants; and (b) stability of sexual contact networks assessed over one-year follow-up. We will compare the productivity (i.e., ratio of undiagnosed cases to number of men screened) of these two case finding methods (n=200/group) in identifying previously undiagnosed MSM (primary outcome). By comparing these forms of network creation to HIV pol sequence data, we aim to identify where gaps exist in the chain(s) of transmission and thereby increase our understanding of the structure of local transmission networks. Longitudinal data will allow us to examine stability of sexual networks, as well as barriers and facilitators of linkage to and retention in care. This is the first study t: 1) determine the effectiveness of case finding methods to identify previously undiagnosed HIV+ cases in a high-risk, understudied population, using state-of-the-art network analyses; 2) use multiple forms of network creation to identify missing connections in sexual contact networks; and 3) identify factors associated with linkage and retention in care among HIV+ MSM in a lower- to middle-income country where this information is severely lacking.

描述（由申请人提供）：该项目的目的是比较两种方法（合作伙伴联系人跟踪[PCT]与基于地点的[VB]招聘）的有效性，以识别在墨西哥蒂华纳（Tijuana）与男性发生性关系（MSM）的先前未诊断的HIV+病例。我们还将使用自我报告的性网络，基于高风险的场地网络和病毒遗传网络（通过对病毒POL序列的分析推断）来识别性传播网络中缺失的连接（例如，匿名伙伴）。在我们的MSM试点数据中，HIV患病率为20.2％，其中88％不知道其HIV+血清抗血清。识别先前未诊断的HIV+人并将其连接到护理中是治疗级联的关键步骤，尤其是在墨西哥的MSM中，受HIV影响不成比例。没有发表的研究检查了案例发现方法与基因分型结合推断性传播网络的方法。将解决三个创新的目标：AIM 1。将PCT与高风险场所（例如性俱乐部）的筛查参与者的有效性进行比较，以此作为在蒂华纳的MSM中找到以前未诊断的HIV+病例的方法。 AIM 2。确定通过PCT与VB性网络产生的性接触网络（通过高危场地中MSMS的分支机构生成的数据）在基线和一年的随访中映射到病毒遗传网络上。目标3。检查PCT与VB病例发现方法及其与（a）与艾滋病毒护理及其心理和环境决定因素的联系和保留的关系； （b）在一年的随访中评估的性接触网络的稳定性。我们将在识别先前未诊断的MSM（主要结果）中比较这两种案例发现方法（n = 200/组）的生产率（即，未诊断的病例与被筛查的男性数量的比率）。通过将这些形式的网络创建与HIV POL序列数据进行比较，我们旨在确定传输链中存在差距的位置，从而增加我们对本地传输网络结构的理解。纵向数据将使我们能够检查性网络的稳定性，以及与链接和保留的障碍和促进者。这是第一项研究t：1）确定使用最先进的网络分析在高风险，研究人群中鉴定先前未诊断的HIV+病例的病例查找方法的有效性； 2）使用多种形式的网络创建来识别性接触网络中缺失的连接； 3）确定在低到中等收入国家中严重缺乏这些信息的艾滋病毒+ MSM之间的联系和保留艾滋病毒+ MSM的保留相关的因素。