Syphilis epidemiology in Columbus, Ohio: a cohort and network study

俄亥俄州哥伦布市的梅毒流行病学：队列和网络研究

• 批准号: 9392414
• 负责人: WILLIAM C MILLER
• 金额: $ 52.97万
• 依托单位: OHIO STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-05-01 至 2020-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9392414
• 关键词: Syphilis; epidemiology; Columbus; Ohio; cohort

SUMMARY Columbus, Ohio is experiencing a syphilis epidemic comparable to many cities across the United States. In Columbus, primary and secondary syphilis cases have more than doubled since 2011. Cases are concentrated in men who have sex with men (MSM). Most cases are among young black MSM under 35 years, but white MSM, especially those aged 35-54 years, also experience significant morbidity. To address this epidemic, we have assembled an outstanding team of investigators and consultants with expertise in epidemiology, behavioral research, clinical management, and network and spatial analyses. Our specific aims are: 1) To conduct formative research to inform recruitment and data collection procedures among MSM in Columbus; 2) To assess the relative contributions of sex partner types, such as online/anonymous, venue-based, social peers, and travelers, to syphilis incidence in Columbus; 3) To assess the spatiotemporal social and sexual network patterns of syphilis transmission in Columbus. In the formative phase (Aim 1), we will use focus groups and in-depth interviews to determine the ideal characteristics of seeds for respondent-driven sampling (RDS) and to assess other characteristics of the MSM community in Columbus. In this phase, we will also develop a predictive model to inform targeted recruitment of MSM at high-risk for reinfection with Treponema pallidum. To accomplish Aims 2 and 3, we will conduct two parallel studies with supplemental network and spatial analyses. One approach will use a prospective cohort of MSM recruited through RDS (n=300) supplemented by an additional sample of MSM at high risk of reinfection (n=60). All cohort participants will be followed with quarterly interviews and testing for syphilis, gonorrhea, chlamydia, and HIV. Behavioral data collection will be augmented with ecological momentary assessment (EMA) with both open (available at any time) and weekly surveys. The primary endpoint will be primary or secondary syphilis. The second approach will use a case cohort study design, a modern epidemiological approach that increases power for rare diseases such as syphilis. In this approach, the cohort serves as a representative sample of high risk MSM, but cases are supplemented with additional primary and secondary syphilis cases from consenting MSM cases identified in the community. The case cohort design will be used to conduct analyses addressing risk factors for syphilis acquisition. We will also conduct extensive network analyses that incorporate information about partnership duration and continuation using syphilis case data from throughout the community, combined with RDS information, partners services data, detailed sexual partner information, social media and app use, and venue visitation data. We will also examine the epidemic with spatiotemporal analyses, including overlaying network and spatial information. Upon completion of this study, we will have developed an actionable understanding of syphilis epidemiology in a Midwestern city with a large MSM population. Our results will permit development of targeted, scalable interventions directed toward controlling this epidemic.

概括 俄亥俄州哥伦布市正在经历与美国许多城市相当的梅毒流行。在 自2011年以来，哥伦布一期和二期梅毒病例增加了一倍多。病例集中 男男性行为者 (MSM)。大多数病例是 35 岁以下的年轻黑人男男性接触者，但白人 MSM，尤其是 35-54 岁的 MSM，发病率也很高。为应对此次疫情，我们 组建了一支由具有流行病学专业知识的调查人员和顾问组成的优秀团队， 行为研究、临床管理以及网络和空间分析。我们的具体目标是： 1) 进行形成性研究，为哥伦布 MSM 的招募和数据收集程序提供信息； 2） 评估性伴侣类型的相对贡献，例如在线/匿名、基于场所、社交 同伴和旅行者对哥伦布梅毒发病率的了解； 3）评估时空社会和性 哥伦布梅毒传播的网络模式。在形成阶段（目标 1），我们将使用焦点 小组和深入访谈，以确定种子的理想特征，以进行受访者驱动的抽样 (RDS) 并评估哥伦布 MSM 社区的其他特征。在这个阶段，我们还将 开发预测模型，为有针对性地招募密螺旋体再感染高风险的 MSM 提供信息 苍白球。为了实现目标 2 和 3，我们将通过补充网络和 空间分析。一种方法是使用通过 RDS 招募的前瞻性 MSM 队列 (n=300) 补充了再次感染高风险的 MSM 额外样本 (n=60)。所有队列参与者都将 随后每季度进行一次访谈并进行梅毒、淋病、衣原体和艾滋病毒检测。行为数据 收集将通过生态瞬时评估 (EMA) 进行扩充，同时开放（可随时获取） 时间）和每周调查。主要终点是一期或二期梅毒。第二种方法 将使用案例队列研究设计，这是一种现代流行病学方法，可增强治疗罕见疾病的能力 例如梅毒。在这种方法中，该队列作为高风险 MSM 的代表性样本，但病例 补充了来自同意的男男性行为者病例中确定的其他一期和二期梅毒病例 在社区中。病例队列设计将用于针对梅毒危险因素进行分析 获得。我们还将进行广泛的网络分析，其中包含有关合作伙伴关系的信息 使用整个社区的梅毒病例数据并结合 RDS 确定持续时间和持续时间 信息、合作伙伴服务数据、详细的性伴侣信息、社交媒体和应用程序使用以及地点 访问数据。我们还将通过时空分析来检查流行病，包括覆盖网络 和空间信息。完成本研究后，我们将对 一个拥有大量 MSM 人口的中西部城市的梅毒流行病学。我们的成果将允许开发 旨在控制这一流行病的有针对性的、可扩展的干预措施。