Wastewater Sampling: A New Tool to Accelerate Ending the HIV Epidemic

废水采样：加速结束艾滋病毒流行的新工具

• 批准号: 10762555
• 负责人: Thomas P Giordano
• 金额: $ 77.68万
• 依托单位: BAYLOR COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-15 至 2028-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10762555
• 关键词: 2019-nCoV; Acceleration; Area; Authorization documentation; Bioethics Consultants; COVID-19; COVID-19 monitoring; COVID-19 outbreak; COVID-19 pandemic; Caring; Clinical Data; Collection; Communities; Complex; Data; Data Reporting; Detection; Diagnosis; Diagnostic; Diagnostic tests; Disease Outbreaks; Epidemic; Epidemiologist; Epidemiology; Ethics; Geographic Locations; Geography; HIV; HIV Infections; HIV diagnosis; Health; Human; Human immunodeficiency virus test; Individual; Infection; Laboratories; Link; Methods; Monitor; Neighborhoods; Nose; Nucleic Acids; Periodicals; Persons; Physicians; Plants; Poliomyelitis; Population; Prevention; Public Health; Recommendation; Reporting; Reproducibility; Research; Research Personnel; Resolution; Resources; Sewage; Sexual Partners; Signal Transduction; Site; Testing; Time; Viral; Viral Load result; Work; antiretroviral therapy; authority; coronavirus disease; epidemiological model; ethical, legal, and social implication; experience; health care availability; improved; novel; novel strategies; outreach; predictive modeling; preference; programs; public health intervention; routine care; sewage treatment; social stigma; success; surveillance data; tool; transmission process; viral detection; virology; wastewater sampling; wastewater testing

PROJECT SUMMARY Current estimates are that 57% of persons in the U.S. with HIV are suppressed, leaving 43% unsuppressed, including about 13% who are undiagnosed and 30% who have been diagnosed but are not currently suppressed. Identifying persons with unsuppressed HIV to link them to care and antiretroviral treatment (ART) is critical for improving health and reducing new infections. New epidemiologic tools that identify in real time communities with high amounts of circulating HIV may enhance efforts to reduce HIV transmission and substantially contribute to ending the HIV epidemic. During the SARS-CoV-2 (SCV2) pandemic, we and others used “wastewater environmental virology” to monitor and respond to COVID. It uses viral capture and PCR detection of viral nucleic acid from wastewater collection sites to detect, quantify, and predict total SCV2 activity in time. We built a robust and mature wastewater sampling program for the Houston region that includes weekly assessment of 39 wastewater collection sites covering about 4 million residents. Our recent preliminary data demonstrate that HIV is detected in wastewater. Wastewater testing is unbiased, comprehensive, real-time, quantitative, and not influenced by access to health care, stigma or denial. We hypothesize that our pioneering wastewater sampling program can be applied as a powerful new tool to identify geographic areas with a high active burden of HIV, reflecting substantial numbers of people with undiagnosed or untreated HIV infection. Resources can then be mobilized to these communities to enhance HIV outreach, testing, prevention and linkage to care. The specifics aims are: 1) To develop a sensitive, reproducible, and streamlined wastewater HIV detection pipeline; 2) To develop epidemiologic models incorporating data from wastewater sampling as a novel and informative parameter along with routine surveillance data on HIV diagnoses and population data; 3) To characterize and incorporate stakeholder preferences, priorities, and recommendations for engaging key community stakeholders in the HIV wastewater sampling program with consideration to the ethical, legal, social, and cultural contexts of individuals living in target neighborhoods; 4) To determine if delivering proven public health interventions to neighborhoods as directed by wastewater data can reduce the wastewater viral load and increase HIV diagnoses in those neighborhoods. This research will enhance the Respond pillar of the End the HIV Epidemic (EHE) strategy. It will leverage and strengthen partnerships between the researchers and the Houston Health Department, the regional public health authority overseeing many EHE programs in Houston. The work in Houston, a high priority EHE region, will result in: (i) the US’s only HIV wastewater sampling program, (ii) epidemiologic models enhanced with wastewater data that identify unmet testing and treatment needs, (iii) community-informed and ethically appropriate, real-time public health monitoring that reduces the number of people with unsuppressed HIV, and (iv) tools and expertise that can be disseminated to other areas.

项目摘要 目前的估计是，美国有57％的艾滋病毒受到抑制，而43％的人不受限制， 包括大约13％的未经诊断的人和30％的人被诊断但未被诊断出 被压制。识别患有未抑制艾滋病毒的人将其与护理和抗逆转录病毒治疗联系起来（ART） 对于改善健康和减少新感染至关重要。实时识别的新流行病学工具 大量流传艾滋病毒的社区可能会加强努力减少艾滋病毒传播和 实质上有助于结束HIV流行。在SARS-COV-2（SCV2）大流行期间，我们和其他人 使用“废水环境病毒学”来监测和响应库维德。它使用病毒捕获和PCR 从废水收集位点检测病毒核酸以检测，量化和预测总SCV2 时间活动。我们为休斯顿地区建立了一个强大而成熟的废水采样计划 包括每周评估39个废水收集地点，约有400万居民。我们的最新消息 初步数据表明，在废水中检测到HIV。废水测试是公正的， 全面，实时，定量，不受获得医疗保健，污名或拒绝的影响。我们 假设我们的开拓性废水采样程序可以作为强大的新工具应用于 识别高活跃艾滋病毒的地理区域，反映了大量患者 未诊断或未治疗的HIV感染。然后可以将资源动员到这些社区以增强 艾滋病毒外展，测试，预防和与护理的联系。具体目的是：1）发展敏感的， 可再现的，流线型的废水HIV检测管道； 2）开发流行病学模型 将废水采样的数据和常规参数合并为新颖的信息参数 有关HIV诊断和人口数据的监视数据； 3）表征并加入利益相关者 与艾滋病毒废水中关键社区利益相关者参与的偏好，优先事项和建议 采样计划以及居住在的个人的道德，法律，社会和文化背景 目标社区； 4）确定是否将经过验证的公共卫生干预措施交付给社区 通过废水数据指导可以减少废水病毒负荷，并增加其中的HIV诊断。 社区。这项研究将增强最终艾滋病毒流行（EHE）策略的响应支柱。 将利用和加强研究人员与休斯顿卫生局之间的伙伴关系， 区域公共卫生局在休斯敦负责许多EHE计划。休斯敦的作品，高高 优先区域将导致：（i）美国唯一的HIV废水采样计划，（ii）流行病学模型 通过识别未满足的测试和治疗需求的废水数据增强，（iii）社区信息和 在道德上适当的实时公共卫生监测，减少了不受欢迎的人数 艾滋病毒，以及（iv）可以传播到其他领域的工具和专业知识。