HIV Transmission Cluster Analysis to Inform Prevention

HIV 传播聚类分析为预防提供信息

• 批准号: 8887384
• 负责人: HONG-HA M TRUONG
• 金额: $ 36.89万
• 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 2016-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8887384
• 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; seroconversion; 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）受到艾滋病毒/艾滋病流行病的影响不成比例。他们通常被统称为高风险群体，但这种概括掩盖了一个事实，即人群中艾滋病毒风险存在高度异质性。某些社会生态因素使一些男同性恋者感染艾滋病毒的风险更高。艾滋病毒流行有许多潜在的驱动因素，包括药物使用、未确诊的感染和性伴侣人数众多。然而，这些广泛的分类需要改进，以便确定传播模式，因为目前尚不清楚哪些驱动因素导致以艾滋病毒传播为生物学结果的流行病。需要实时识别流行病学热点，查明病毒传播链和将流行病的驱动因素与生物学联系起来，以便有效地针对预防战略并中断这些艾滋病毒传播链。根据修订后的临床指南，越来越多地使用抗逆转录病毒（ARV）耐药检测丰富了该领域