Evaluating STI screening and antimicrobial resistance in Neisseria gonorrhoeae among PrEP users in Vietnam

项目摘要 男男性行为者（MSM）感染艾滋病毒和性传播感染的风险更高 增加艾滋病风险，如淋病奈瑟菌和沙眼衣原体。HIV暴露前 预防性治疗（PrEP）的使用者--其中许多是MSM--也面临着增加的性传播感染风险。美国指南 建议PrEP使用者在多个解剖部位（咽部、泌尿生殖器， 和直肠）用于无症状感染者。然而，低收入和中等收入国家缺乏这种能力， 指南，导致LMIC PrEP用户错过了STI筛查和治疗的机会。 耐药性（AMR）的N。淋病是一种紧迫的全球健康威胁， 在获得诊断的机会有限的中低收入国家，这一比例最高。特别是西太平洋区域， 包括越南的LMIC在内，已经看到N.淋病，它已经蔓延到 国际吧在了解N.淋病在中低收入国家 在这项研究中，来自加州大学洛杉矶分校和河内医科大学的研究人员将调查 C的可行性。trachomatis和N.在从事艾滋病毒感染的男男性接触者和变性妇女中进行淋病筛查 越南河内的PrEP计划。我们假设筛查是可接受的和可行的。我们还将 研究耐药性危险因素以及耐药奈瑟菌和奈瑟菌之间的基因组关系。淋病 在与AMR相关的遗传位点，假设最近使用抗生素是AMR的危险因素。 目的1：（a）确定肛门直肠、咽部和泌尿生殖道念珠菌的分布。trachomatis和N. 越南河内的MSM和变性女性PrEP使用者（n = 1，300）中的淋病感染和（B） 评估快速三点检测的可接受性和可行性，包括支付意愿。 目的2：（a）收集、培养和药敏试验。淋病和口咽 奈瑟氏菌属物种，以研究AMR的患病率和相关性，和B）进行全基因组测序。 对N.淋病和奈瑟菌属物种分离自同一个人， 研究与N.淋病 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，将涉及研究的发展 材料、规划和培训。第二阶段将持续一年，将评估C。 trachomatis和N.淋病筛查第三阶段将持续9个月， 敏感性测试和全基因组测序。第四阶段将持续3个月， 通过手稿、演示以及与当地政府和卫生机构共享数据来收集和分析研究结果。 这项研究的结果将为未来的R01提案奠定基础，以调查日常生活的影响。 筛选和治疗性传播感染对耐药性的发展是N。淋病

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.