Rapid Response to Incident HIV Infection through Social Network Strategies and Molecular Epidemiology to Inform Partner Services

项目总结 拟议研究的目标是通过让 黑人男性与男性性行为网络(BMSM)和变性女性网络(TGW)通过 合作伙伴服务、社交网络招聘和艾滋病毒基因集群检测的组合。尽管 在艾滋病毒治疗和预防方面取得了显著进展，艾滋病毒发病率在 美国南部的BMSM/TGW，强调需要创新的方法来检测和 应对持续的艾滋病毒传播。虽然合作伙伴服务可以非常有效，但案例查找仍然有效 即使是在感染艾滋病毒后不久被确诊的人(急性或新近感染)也是有限的。合作伙伴服务 也可以局限于跨管辖边界和农村地区的调查。我们假设 利用社交网络(社交网络，而不仅仅是毒品共享或性伴侣) 最近艾滋病毒的传播将导致改善对艾滋病毒服务的参与(预防或护理)。然而， 此类战略必须对参与这些服务的障碍和促进者做出反应，包括 更好地了解社会支持网络。该项目涉及一个多学科团队，包括Robust 公共卫生伙伴关系和社区积极参与，以满足艾滋病毒预防需求并在此基础上 现有资源。我们将制定和实施针对网络的增强型社交网络战略(ESN 在高负担的夏洛特地区，BMSM/TGW有新的艾滋病毒诊断，包括急性事件感染 (北卡罗来纳州梅克伦堡县)，位于南卡罗来纳州边界。这两个领域都是优先地区 在结束流行病(EHE)倡议中。在eSNs的干预中，新的诊断将得到快速 响应合作伙伴服务，以激发社交和性接触；将招募选定的联系人并 被指导招募他们的同龄人从事艾滋病毒服务。AIM 1将采用区域遗传和接触 北卡罗来纳州和南卡罗来纳州艾滋病毒事件和流行的网络分析，以评估重要联系 (桥梁)州与州之间、城市与农村之间。这些细粒度数据(接触、空间、遗传)将 扩大对疫情的流行病学了解，为社区卫生服务中心的发展提供信息，并加强当地 每种策略。为了进一步了解ESNS的发展，AIM 2将使用混合方法来研究 与最近艾滋病毒传播网络的BMSM/TGW成员接触的障碍和促进者。目标 3然后将根据有效性和执行结果对环境监测网络进行评估。有效性结果 (增加检测、暴露前预防转诊和艾滋病毒护理参与度)将通过 回归点位移量设计比较夏洛特市干预前后的结果 与罗利地区接受标准护理合作伙伴服务进行比较。总体而言，这一结果 项目将提供关键信息，以指导合作伙伴服务中的新战略以及EHE对 增加美国南部BMSM/TGW中艾滋病毒护理和预防的参与度。

PROJECT SUMMARY The objective of the proposed research is to improve the response to incident HIV infection by engaging the networks of Black men who have sex with men (BMSM) and transgender women (TGW) through a combination of Partner Services, social network recruitment, and HIV genetic cluster detection. Despite marked advances in HIV treatment and prevention, HIV incidence has not substantially declined among BMSM/TGW in the Southern United States (US), highlighting the need for innovative methods to detect and respond to ongoing HIV transmission. While Partner Services can be highly effective, case finding remains limited even for persons diagnosed soon after HIV acquisition (acute or recent infections). Partner Services can also be limited in investigations across jurisdictional boundaries and in rural areas. We hypothesize that leveraging the social networks (social contacts rather than only drug sharing or sexual partners) of networks with recent HIV transmission will lead to improved engagement in HIV services (prevention or care). However, such strategies must be responsive to the barriers and facilitators to engagement in these services including a better understanding of social support networks. This project involves a multidisciplinary team including robust public health partnerships and active community engagement to address HIV prevention needs and build on existing resources. We will develop and implement an enhanced social network strategy (eSNS) for networks of BMSM/TGW with new HIV diagnoses, including acute incident infection, in the high-burden Charlotte region (Mecklenburg County, North Carolina), situated on the border of South Carolina. Both areas are priority regions in the Ending the Epidemic (EHE) initiative. In the eSNS intervention, new diagnoses will receive rapid response Partner Services for elicitation of social and sexual contacts; selected contacts will be recruited and coached to recruit their peers to engage in HIV services. Aim 1 will employ regional genetic and contact network analysis of incident and prevalent HIV in North and South Carolina, to evaluate important connections (bridging) between states and between urban and rural areas. This granular data (contact, spatial, genetic) will expand epidemiological understanding of the epidemic to inform development of the eSNS and enhance local EHE strategies. To further inform eSNS development, Aim 2 will use a mixed methods approach to examine the barriers and facilitators of engaging BMSM/TGW members of networks with recent HIV transmission. Aim 3 will then evaluate the eSNS with effectiveness and implementation outcomes. Effectiveness outcomes (increase in testing, pre-exposure prophylaxis referral, and HIV care engagement) will be evaluated with regression point displacement design comparing outcomes pre/post intervention in Charlotte and in comparison, with the Raleigh region receiving standard of care partner services. Overall, the results of this project will lead to critical information to guide new strategies in Partner Services and in EHE responses to increase HIV care and prevention engagement among BMSM/TGW in the Southern US.