Reaching Unaware Sexual and Social Contacts to Interrupt Ongoing HIV Transmission

实现不知情的性接触和社会接触以中断持续的艾滋病毒传播

• 批准号: 9323267
• 负责人: WILLIAM C MILLER
• 金额: $ 62.73万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-08-15 至 2019-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9323267
• 关键词: Acute; Address; Africa South of the Sahara; African; Algorithms; Awareness; Biological Assay; Caring; Chronic; Clinic; Cluster Analysis; Contracts; Detection; Development; Diagnostic; Effectiveness; Epidemic; Evaluation; Event; Fostering; Friends; HIV; HIV Infections; HIV Seropositivity; HIV diagnosis; HIV-1; Health; Health Personnel; Human immunodeficiency virus test; Incidence; Infection; Interruption; Intervention; Knowledge; Lead; Link; Malawi; Methods; Modeling; Newly Diagnosed; Participant; Partner Notification; Persons; Phylogenetic Analysis; Population; Prevention; Probability; RNA; Recruitment Activity; Research; Risk; Risk Behaviors; Serologic tests; Sex Behavior; Sexual Partners; Sexually Transmitted Diseases; Site; Social Environment; Social Network; Staging; Testing; Time; Viral Load result; Virus; Work; antiretroviral therapy; base; cost efficient; deep sequencing; experience; genetic linkage analysis; high risk; high risk behavior; high risk sexual behavior; indexing; insight; mathematical model; novel; peer; prevent; public health relevance; seropositive; social; transmission process

DESCRIPTION (provided by applicant): Persons unaware of their HIV infection contribute disproportionately to ongoing HIV transmission. Treatment as prevention (TasP) depends on reaching HIV-infected persons for HIV testing and diagnosis, linking them to care, and initiating antiretroviral therapy. TasP effectiveness may be reduced if a significant proportion of ongoing transmission is related to acute or recent HIV infection, but acute HIV infection (AHI) presents diagnostic challenges. Identifying persons with AHI and recent infection may be critical for the realization of the full potential of TasP. Partner notification is an underused strategy in sub-Saharan Africa to identify persons with undiagnosed HIV infection. Contract partner notification is a cost-efficient form of partner notification, in which newly diagnosed HIV-infected persons are given a limited time to notify their sexual partners, followed by active tracing by health personnel. Social contact referral involves referral of peers for HIV testing. The rationale for ths approach is that social contacts of HIV-infected persons are likely to share similar high-risk behaviors, thereby increasing their likelihood of HIV infection. Our central hypotheses are: 1) Partner notification and social contact referral of newly identified HIV- infected STI clinic patros will effectively identify HIV-infected-but-unaware persons at high risk for ongoing transmission, and 2) HIV-infected unaware sexual partners and social contacts of persons with acute and recent HIV infection will have greater potential for HIV transmission, based on sexual behavior, viral load, and cluster membership, than unaware sexual partners and social contacts of chronically HIV-infected persons. We will address these hypotheses in Lilongwe, Malawi with three specific aims: Aim 1: To evaluate an "unaware intervention package", including detection of AHI, contract partner notification, and social contact referral, to find persons unaware of thei HIV infection; Aim 2: To characterize the potential for ongoing HIV transmission through evaluation of sexual behaviors, awareness of HIV status, viral load, and phylogenetic clustering among acute, recent, and chronically HIV-infected STI clinic patrons and their sexual partners and social contacts; Aim 3: To assess the potential for AHI detection, contract partner notification, and social contact referral to reduce HIV incidence using mathematical modeling. To address these aims, we will recruit HIV-infected persons in two sexually transmitted infection clinics in Malawi. We will assess an unaware intervention package combining AHI detection, contract partner notification, and social contact referral. We will stage the HIV infection of inde participants, sexual partners and social contacts using HIV serology, HIV RNA PCR, a multi-assay algorithm, and an exploratory deep sequencing approach. Phylogenetic linkage and cluster analyses will be performed for all identified infections. Mathematical modeling will be used to assess the potential population-level impact of these interventions.

描述（由申请人提供）：不知道自己感染艾滋病毒的人对艾滋病毒的持续传播造成了不成比例的影响。治疗即预防 (TasP) 取决于对艾滋病毒感染者进行艾滋病毒检测和诊断、将他们与护理联系起来并启动抗逆转录病毒治疗。如果很大一部分持续传播与急性或近期 HIV 感染有关，TasP 的有效性可能会降低，但急性 HIV 感染 (AHI) 提出了诊断挑战。识别 AHI 患者和近期感染者对于充分发挥 TasP 的潜力可能至关重要。 在撒哈拉以南非洲地区，合作伙伴通知是一项未得到充分利用的策略，用于识别未确诊的艾滋病毒感染者。合同伙伴通知是一种具有成本效益的伙伴通知形式，其中新诊断的艾滋病毒感染者会在有限的时间内通知其性伙伴，然后由卫生人员主动追踪。社会联系转介涉及转介同伴进行艾滋病毒检测。这种方法的基本原理是，艾滋病毒感染者的社会接触者可能有类似的高风险行为，从而增加了他们感染艾滋病毒的可能性。 我们的中心假设是：1) 对新发现的感染艾滋病毒的性传播感染诊所巡诊人员进行伴侣通知和社会接触转介，将有效地识别处于持续传播高风险的艾滋病毒感染者但不知情的人，以及 2) 感染艾滋病毒的不知情的性伴侣和根据性行为、病毒载量和群体成员身份，急性和近期艾滋病毒感染者的社会接触比不知情的性伴侣和慢性艾滋病毒感染者的社会接触更有可能传播艾滋病毒。我们将在马拉维利隆圭解决这些假设，并实现三个具体目标： 目标 1：评估“无意识干预方案”，包括 AHI 检测、合同伙伴通知和社会联系人转介，以找到不知晓 HIV 感染的人；目标 2：通过评估急性、近期和慢性感染 HIV 的 STI 诊所顾客及其性伴侣和社会接触者的性行为、对 HIV 状况的认识、病毒载量和系统发育聚类来描述持续 HIV 传播的可能性；目标 3：使用数学模型评估 AHI 检测、合同伙伴通知和社会接触转介降低 HIV 发病率的潜力。 为了实现这些目标，我们将在马拉维的两个性传播感染诊所招募艾滋病毒感染者。我们将评估一个结合 AHI 检测、合同伙伴通知和社交联系推荐的无意识干预方案。我们将使用 HIV 血清学、HIV RNA PCR、多重检测算法和探索性深度测序方法对 inde 参与者、性伴侣和社会接触者进行 HIV 感染分阶段。将对所有已识别的感染进行系统发育连锁和聚类分析。数学模型将用于评估这些干预措施对人口水平的潜在影响。