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

项目摘要 拟议研究的目的是通过让艾滋病毒感染者参与， 与男性发生性关系的黑人男子（BMSM）和变性妇女（TGW）通过一个 合作伙伴服务、社交网络招募和艾滋病毒基因簇检测的组合。尽管 尽管艾滋病毒治疗和预防工作取得了显著进展，但艾滋病毒发病率在 BMSM/TGW在美国南部（US），强调需要创新的方法来检测和 应对艾滋病毒的持续传播。虽然合作伙伴服务可以非常有效，但案例发现仍然存在 即使是在感染艾滋病毒后不久（急性或近期感染）被诊断出的人，也是有限的。合作伙伴服务 在跨司法管辖区和农村地区的调查中也可能受到限制。我们假设 利用网络的社交网络（社会联系，而不仅仅是药物共享或性伙伴） 最近的艾滋病毒传播将导致更好地参与艾滋病毒服务（预防或护理）。然而，在这方面， 这些战略必须对参与这些服务的障碍和促进因素作出反应，包括 更好地了解社会支持网络。该项目涉及一个多学科的团队，包括强大的 建立公共卫生伙伴关系和积极的社区参与，以满足艾滋病毒预防需求， 现有资源。我们将为网络制定和实施增强型社交网络战略（eSNS） 在高负担的夏洛特地区，BMSM/TGW新诊断出艾滋病毒，包括急性事件感染 （梅克伦堡县，北卡罗来纳州），位于南卡罗来纳州边界。这两个领域都是优先区域 结束流行病（EHE）倡议。在eSNS干预中，新的诊断将迅速得到 回应合作伙伴服务，以吸引社会和性接触;将招募选定的接触者， 指导他们招募同伴参与艾滋病毒服务。目标1将采用区域遗传和接触 对北卡罗来纳州和南卡罗来纳州的艾滋病毒事件和流行情况进行网络分析，以评估重要联系 国家之间以及城市和农村地区之间的联系。这种粒度数据（接触、空间、遗传）将 扩大对流行病的流行病学了解，为eSNS的发展提供信息， EHE战略。为了进一步为SNS开发提供信息，Aim 2将使用混合方法来检查 使BMSM/TGW网络成员参与最近的艾滋病毒传播的障碍和促进因素。目的 然后，3将评估eSNS的有效性和实施成果。有效性结局 （检测、暴露前预防转诊和艾滋病毒护理参与的增加）将进行评估， 回归点位移设计，比较夏洛特和 相比之下，罗利地区接受护理伙伴服务的标准。总的来说，这一结果 该项目将提供关键信息，以指导合作伙伴服务和EHE响应中的新战略， 增加美国南部BMSM/TGW的艾滋病毒护理和预防参与。

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.