Seek and Treat for Optimal Prevention of HIV & AIDS (STOP HIV/AIDS) in BC

寻求和治疗以最佳预防艾滋病毒

• 批准号: 8841486
• 负责人: Julio Sergio Gonzalez Montaner
• 金额: $ 10.8万
• 依托单位: UNIVERSITY OF BRITISH COLUMBIA
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-06-01 至 2018-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8841486
• 关键词: AIDS prevention; AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Address; Affect; Antiretroviral drug resistance; Area; Award; British Columbia; Canada; Caring; Charge; Cities; Clinical; Clinical Research; Clinical Trials; Consensus; Data; Data Collection; Databases; Development; Disease; Drug resistance; Elements; Epidemiologic Studies; Epidemiology; Extravasation; Funding; Generations; Geographic Information Systems; Government; HIV; HIV Infections; HIV diagnosis; Health; Health Priorities; Health Services Accessibility; Healthcare; Healthcare Systems; Heterogeneity; Highly Active Antiretroviral Therapy; Human immunodeficiency virus test; Illicit Drugs; Incidence; Individual; Infection; Interdisciplinary Study; International; Intervention; Investments; Laboratories; Link; Marshal; Measures; Medical; Methods; Modeling; Molecular Genetics; Monitor; Morbidity - disease rate; National Institute of Drug Abuse; North America; Observational Study; Outcome; Pathogenesis; Pattern; Pharmaceutical Preparations; Phylogenetic Analysis; Population; Positioning Attribute; Prevention; Province; Randomized Controlled Trials; Request for Applications; Research; Research Activity; Research Infrastructure; Residual state; Resistance; Risk; Techniques; Technology; Testing; Time; United States National Institutes of Health; Viral; Vulnerable Populations; Work; addiction; base; cohort; development policy; experience; health care service utilization; innovation; innovative technologies; mathematical model; member; mortality; new technology; next generation sequencing; novel; outreach; population based; prevent; programs; public health emergency; public health relevance; response; substance abuse treatment; success; tool; transmission process

DESCRIPTION (provided by applicant): This application requests funding to undertake innovative research on a large-scale population-based Seek, Test, Treat and Retain (STTR) initiative. The Province of British Columbia (Canada) has embarked upon one of the world's largest and most advanced STTR initiatives, which was renewed in November 2012. The universal healthcare system within the province provides all medical care, including highly active antiretroviral therapy (HAART) and substance abuse treatment, free of charge. Extensive confidential record linkages allow the accurate attainment of all key measures, including health service utilization and HIV clinical outcomes. Taking advantage of this initiative and a large linked database, as well as the interdisciplinary research capacity of the British Columbia Centre for Excellence in HIV/AIDS (Vancouver), herein we propose a program of rigorous and innovative study that will marshal epidemiologic, clinical, geographic, and phylogenetic approaches to critically inform efforts to respond to HIV transmission and pathogenesis among HIV-infected individuals, with a particular emphasis on individuals who inject drugs (IDU). Specifically, we seek to augment our ongoing epidemiologic and clinical research activities with molecular genetics and geographic information systems (GIS) based methods to model the effect of this STTR initiative on the generation of antiretroviral drug resistance and HIV incidence. As well, we will use novel phylogenetic methods and next generation sequencing to assess the suitability of new HIV diagnoses as a surrogate for HIV incidence. In order to aid in the optimization of STTR approaches, we will also identify patterns and predictors of engagement in and leakage from the "Cascade of Care' among IDU. Lastly, by integrating GIS with phylogenetic data, we will identify unrecognized foci of HIV transmission throughout the province. This proposal comes at a time of international consensus on the need to respond urgently to elevated levels of HIV-related morbidity and mortality, particularly among IDU. Evidence from mathematical modeling, observational cohorts and clinical trials has revealed the close link between HAART access and the risk of HIV transmission between individuals, resulting in markedly lower rates of infection in populations with higher levels of coverage of HAART. This observation has led to renewed HIV prevention efforts to seek out members of vulnerable populations, test them for HIV infection, and engage them in healthcare, including treatment for HIV infection, in order to reduce HIV-related morbidity and mortality and lower HIV incidence. Given the research infrastructure established to date and our track record in undertaking novel and high impact research on STTR, we are uniquely well placed to prospectively assess key second-generation questions regarding the impact of STTR on engagement in treatment and care, HAART resistance, and HIV incidence. The work proposed herein is strongly aligned with the priorities in the FY 2013 Trans-NIH Plan for HIV-Related Research.

描述（由申请人提供）：本申请需要资金来开展大规模基于人群的“寻找、测试、治疗和保留”(STTR) 计划的创新研究。不列颠哥伦比亚省（加拿大）已着手实施世界上规模最大、最先进的 STTR 举措之一，并于 2012 年 11 月更新。该省的全民医疗保健系统免费提供所有医疗护理，包括高效抗逆转录病毒治疗 (HAART) 和药物滥用治疗。广泛的机密记录链接可以准确实现所有关键指标，包括卫生服务利用和艾滋病毒临床结果。利用这一举措和大型链接数据库，以及不列颠哥伦比亚省艾滋病毒/艾滋病卓越中心（温哥华）的跨学科研究能力，我们在此提出了一项严格和创新的研究计划，该计划将整合流行病学、临床、地理和系统发生方法，为应对艾滋病毒感染者中的艾滋病毒传播和发病机制提供重要信息，特别是 重点关注注射吸毒者 (IDU)。具体来说，我们寻求通过基于分子遗传学和地理信息系统（GIS）的方法来增强我们正在进行的流行病学和临床研究活动，以模拟该 STTR 举措对抗逆转录病毒耐药性和艾滋病毒发病率产生的影响。此外，我们将使用新的系统发育方法和下一代测序来评估新的艾滋病毒诊断作为艾滋病毒发病率替代指标的适用性。为了帮助优化 STTR 方法，我们还将确定注射吸毒者中参与和泄漏“级联护理”的模式和预测因素。最后，通过将 GIS 与系统发育数据相结合，我们将确定全省范围内未被识别的艾滋病毒传播焦点。这项提议是在国际社会就需要紧急应对艾滋病毒相关发病率和死亡率（特别是注射吸毒者中）升高水平达成共识之际提出的。 来自数学模型、观察队列和临床试验的证据揭示了HAART的获得与个体之间HIV传播的风险之间的密切联系，导致HAART覆盖率较高的人群的感染率明显较低。这一观察结果导致重新开展艾滋病毒预防工作，寻找弱势群体成员，对他们进行艾滋病毒感染检测，并让他们参与医疗保健，包括治疗艾滋病毒感染，以减少艾滋病毒感染的发生。 与艾滋病毒相关的发病率和死亡率以及较低的艾滋病毒发病率。鉴于迄今为止建立的研究基础设施以及我们在开展 STTR 新颖且高影响力研究方面的记录，我们处于独特的有利位置，可以前瞻性地评估有关 STTR 对治疗和护理参与、HAART 耐药性和 HIV 发病率影响的第二代关键问题。本文提出的工作与 2013 财年跨 NIH 计划中的优先事项高度一致 艾滋病毒相关研究。