HIV Transmission Cluster Analysis to Inform Prevention

HIV 传播聚类分析为预防提供信息

• 批准号: 8523979
• 负责人: HONG-HA M TRUONG
• 金额: $ 37.04万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-01 至 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8523979
• 关键词: AIDS prevention; AIDS/HIV problem; Accounting; Acute; Affect; Alcohol or Other Drugs use; Antiretroviral resistance; Behavior; Behavioral; Biological; Caring; Categories; Chemoprophylaxis; Clinical; Cluster Analysis; Communication; Complement; DNA Sequence; Data; Databases; Development; Epidemic; Epidemiology; Genetic; Guidelines; HIV; HIV Infections; HIV risk; Hand; Heterogeneity; Heterosexuals; Hot Spot; Infection; Injecting drug user; Intervention; Interview; Laboratories; Link; Methodology; Modeling; Molecular; Outcome; Pattern; Persons; Phylogenetic Analysis; Population; Prevention; Prevention strategy; Registries; Relative (related person); Reporting; Research; Resistance; Risk Reduction; Sexual Partners; Sexually Transmitted Diseases; Source; Specificity; Techniques; Testing; Time; Viral; Virus; Woman; disease diagnosis; disease transmission; high risk; innovation; insight; men; men who have sex with men; population based; prevent; psychosocial; response; sex; social; stem; therapy development; tool; transmission process; urban area; viral resistance

DESCRIPTION (provided by applicant): Men who have sex with men (MSM) are disproportionately affected by the HIV/AIDS epidemic. They are often referred to collectively as a high-risk group, but this generalization belies the fact that there is a high degree of heterogeneity of HIV risk within the population. Certain socio-ecological factors place some MSM at higher risk for HIV. There are a number of potential drivers of the HIV epidemic, including substance use, undiagnosed infections and high number of sexual partners. However, these broad categories need refinement in order to identify transmission patterns, as it remains unclear which drivers are contributing to the epidemic with HIV transmission as the biological outcome. Real-time identification of epidemiological hot spots, pinpointing the chains of viral transmission and biologically linking drivers of the epidemic are needed to effectively target prevention strategies and interrupt these chains of HIV transmission. Increasing use of antiretroviral (ARV) resistance testing in response to revised clinical guidelines has enriched the availability of viral sequences to study HIV transmission epidemiology. DNA sequencing can be used to establish epidemiological linkages between infected persons. Such linkages are referred to as HIV transmission clusters, comprised of cases whose viruses share sufficient phylogenetic similarities to suggest a recent common source of infection or participation in linked chains of transmission. Identifying clusters that account for the largest proportion of onward transmissions and characterizing the structural, behavioral and biological correlates that predict transmissibility would inform the development of targeted interventions. The proposed study will use a combination of biological, epidemiological, behavioral and psychosocial research tools to obtain an innovative perspective on the HIV epidemic among MSM. The specific aims are: 1) to characterize HIV transmission clusters and correlates associated with transmission; 2) to evaluate the relative impact of acute, recent and long-term HIV infections on transmission clusters; and 3) to assess HIV transmission cluster patterns in relation to attempted risk reduction strategies. We are poised to analyze viral sequences to elucidate the key patterns of HIV transmission. We will enhance the utility of existing data by creating a population-based, analytical database that will harmonize an urban area's HIV/AIDS case registry with viral resistance and sexually transmitted diseases databases. Qualitative interviews will be conducted to describe the psychosocial and behavioral contexts at the level of the transmission cluster to complement the phylogenetic data. Using an adapted Social Ecological model as a conceptual framework, the interviews will elicit seroconversion narratives and obtain detailed data on any specific strategies attempted to prevent HIV transmission. Real-time analysis of HIV transmission cluster data will place us on the leading edge of the epidemic and enable assessment of how high-risk clusters and current prevention strategies affect transmission patterns.

描述(由申请人提供)：男男性行为者(MSM)受艾滋病毒/艾滋病流行的影响不成比例。他们通常被统称为高危群体，但这一概括掩盖了这样一个事实，即人群中艾滋病毒风险的高度异质性。某些社会生态因素使一些男男性接触者感染艾滋病毒的风险更高。艾滋病毒流行的潜在驱动因素有许多，包括药物使用、未诊断的感染和性伴侣数量过多。然而，这些广泛的类别需要改进，以确定传播模式，因为目前尚不清楚哪些驱动因素导致了这一流行病，艾滋病毒传播是生物结果。需要实时确定流行病学热点，查明病毒传播链和流行病的生物联系的驱动因素，以便有效地针对预防战略并切断这些艾滋病毒传播链。为响应修订的临床指南，越来越多地使用抗逆转录病毒(ARV)耐药性测试，丰富了 病毒序列的可用性，以研究艾滋病毒传播流行病学。DNA测序可用于建立感染者之间的流行病学联系。这种联系被称为艾滋病毒传播集群，由病毒具有足够的系统发育相似性的病例组成，表明最近有共同的感染源或参与了相互关联的传播链。确定在后续传播中占最大比例的集群，并确定预测传播性的结构、行为和生物相关性，将为制定有针对性的干预措施提供信息。这项拟议的研究将结合生物学、流行病学、行为学和心理学研究工具，对男男性接触者中的艾滋病毒流行获得一个创新的视角。具体目标是：1)确定艾滋病毒传播集群的特征和与传播有关的相关因素；2)评估急性、近期和长期艾滋病毒感染对传播集群的相对影响；3)评估与尝试的降低风险战略有关的艾滋病毒传播集群模式。我们准备分析病毒序列，以阐明艾滋病毒传播的关键模式。我们将建立一个以人口为基础的分析数据库，将城市地区的艾滋病毒/艾滋病病例登记与病毒耐药性和性传播疾病数据库统一起来，从而提高现有数据的效用。将进行定性访谈，以描述传播群一级的心理社会和行为背景，以补充系统发育数据。以适应的社会生态模型作为概念框架，访谈将引出血清转换的叙述，并获得关于试图预防艾滋病毒传播的任何具体战略的详细数据。对艾滋病毒传播群组数据的实时分析将使我们处于流行病的前沿，并能够评估高风险群组和当前的预防战略如何影响传播模式。