The changing face of HIV in the era of COVID-19: Maximising HIV incidence reduction through dynamic targeting of current and future distributions of acquisition risk.

项目摘要 南非是世界上艾滋病毒流行最严重的国家，目前有780万人感染 爱滋病毒。在过去的十年中，艾滋病毒治疗和预防的规模扩大，导致减少了 在2010至2020年间，近一半的新增艾滋病毒感染和艾滋病相关死亡病例。 尽管取得了这一成功，但我们的团队提出的证据表明，新的 感染在时间和空间上以及跨年龄和性别的阶层中并不是相同的。这种不均衡 降低风险导致艾滋病毒风险格局发生转变，从而出现了新的 弱势群体。两个重大事件可能会导致风险格局的进一步变化。 第一个是转向基于多洛替格列韦的抗逆转录病毒治疗方案。第二个是 新冠肺炎大流行造成的卫生服务中断史无前例 艾滋病毒护理提供方面的挑战。 我们对这项提议的长期目标是设计下一代艾滋病毒的联合预防 撒哈拉以南非洲贫困农村社区的战略，这将最大限度地提高艾滋病毒发病率 通过确定和瞄准最脆弱的次级群体来减少。我们设想 及早识别新出现的脆弱亚群将成为 有效的程序性回应。我们的项目将利用正在进行的最大规模的 世界上以人口为基础的艾滋病毒队列-非洲卫生研究所的人口 夸祖鲁-纳塔尔农村的队列，具有个人水平的社会人口学、生物学和临床数据 以及在完全集成的个人数据平台中的全面基因组数据。这个 该项目将利用研究所现有的基础设施和高分辨率数据来(I)量化 新的艾滋病毒感染的空间、时间和人口负担的变化(2022-2026)； 和(2)利用艾滋病毒流行动态的变化设计未来的干预措施 将根据大多数人的动态需求最大限度地减少艾滋病毒发病率的计划 脆弱的亚群。

Project Summary South Africa has the largest HIV epidemic worldwide with 7.8 million people currently living with HIV. The scaling up of HIV treatment and prevention over the past decade has led to a reduction of nearly half of new HIV infections and AIDS related deaths between 2010 and 2020. Notwithstanding this success, our team has presented evidence showing that reduction in new infections is not homogeneous over time and space and across the age-sex strata. This uneven risk reduction has led to a shift in the HIV risk landscape resulting in the emergence of new vulnerable groups. Two major events are likely to cause further changes to the risk landscape. The first is the shift to Dolutegravir-based antiretroviral treatment regimens. The second is the disruptions of health services caused by the COVID-19 pandemic creating unprecedented challenges in HIV care delivery. Our long-term goal for this proposal is to design the next-generation HIV combination prevention strategies for poor rural communities in sub-Saharan Africa, which will maximize HIV incidence reduction through identification and targeting of the most vulnerable sub-groups. We envisage that early identification of emergent vulnerable subpopulations would become a key element for an effective programmatic response. Our project will take advantage of one of the largest ongoing population-based HIV cohorts in the world – the Africa Health Research Institute’s population cohort in rural KwaZulu-Natal, with individual-level sociodemographic, biological, and clinical data as well as comprehensive genomics data in the fully integrated individual data platform. The project will leverage the institute’s existing infrastructure and high-resolution data to (i) Quantify the shifts in the spatial, temporal and demographic burden of new HIV infections (2022-2026); and (ii) Harness the changes in the dynamics of the HIV epidemic to design future intervention programs which will maximize HIV incidence reduction based on the dynamic needs of the most vulnerable sub-populations.