Emory WIHS CRS - Longitudinal Cohort

描述（由申请人提供）：亚特兰大，由于其艾滋病毒流行的规模大，将作为招募艾滋病毒感染和高危妇女的理想地点，这些妇女是南方流行病的代表，参加妇女机构间健康研究（WIHS）。纳入亚特兰大将扩大WIHS的研究专长和议程，包括埃默里大学教师在全国领先的专家领域。Emory CRS的潜力是显而易见的，从数百名妇女参与艾滋病毒研究的经验和出色的记录中可以看出，包括DAIDS支持的网络（ACTG， HPTN， HVTN）试验，以及与妇女健康相关的最先进的研究能力（阴道镜检查，DXA和fMRI，颈动脉内膜超声，心脏CT，局部标本库等）。我们的艾滋病毒临床活动的规模包括7,921名患者（22%为女性），其中950名是新诊断和未接受抗逆转录病毒治疗的患者，这为使WIHS队列多样化提供了独特的机会。通过埃默里研究人员、县卫生部门和该州社区组织之间的长期合作，埃默里WIHS CRS将吸引来自佐治亚州农村和难以到达的社区的合格受试者，以更好地描述南部流行病人口结构的变化。将采用与基于社区的参与性研究相一致的原则指导的创新方法来招募、联系和留住妇女。埃默里大学WIHS申请的首要重点是“通过免疫学、临床、药理学、流行病学和行为研究为妇女提供艾滋病毒/艾滋病二级预防”。我们的愿景是在有效的行为和临床干预方面做出重大贡献，并探索针对感染艾滋病毒的妇女的免疫学，流行病学和药理学活动。这一愿景在我们的多站点研究计划“Emory SWEET试验”中得以实现，这是一项创新的可实施智能手机干预，旨在提高抗逆转录病毒药物的依从性，促进减少危害，降低性病发病率，并改善艾滋病毒感染和高危妇女的整体临床和生物医学结果。该项目利用埃默里大学顶尖科学家的专业知识，利用当地的WIHS队列，研究HAART和PrEP中常用抗逆转录病毒药物的细胞内药代动力学，通过夫妇自愿咨询和艾滋病毒检测确定影响艾滋病毒感染妇女生活的双元特征，并检查外周血和女性生殖道中的B细胞亚群、PD- 1表达和血清学记忆。以更好地表征HIV感染对生殖器粘膜免疫的影响。

DESCRIPTION (provided by applicant): Atlanta, due to the large size of its HIV epidemic, will serve as the ideal site to recruit HIV-infected and at-risk women who are representative of the Southern epidemic into the Women's Interagency Health Study (WIHS). Inclusion of Atlanta will expand the WIHS research expertise and agenda to include areas for which the Emory faculty are leading experts nationally. The potential of an Emory CRS is evident from the experience and excellent track record in the accrual of hundreds of women into HIV research including the DAIDS supported networks (ACTG, HPTN, HVTN) trials, and from the availability of state-of-the-art research capacity relevant to women's health (colposcopy, DXA and fMRI, carotid intima ultrasound, cardiac CT, local specimen repository, etc.). The size of our HIV clinical activities, which include 7,921 patients (22% women), 950 whom are newly diagnosed and antiretroviral treatment naive, offers a unique opportunity to diversify the WIHS cohort. Through long-standing collaboration between Emory investigators, county health departments, and community based organizations in the state, the Emory WIHS CRS will attract eligible subjects from rural Georgia and from the hard-to-reach communities to better characterize the changing demographics of the epidemic in the South. Innovative approaches guided by principles aligned with community-based participatory research will be employed to recruit, link, and retain women in the WIHS cohort. The overarching focus of the Emory WIHS application is "HIV/AIDS secondary prevention for women through immunological, clinical, pharmacological, epidemiological and behavioral research." Our vision is to make major contributions in effective behavioral and clinical interventions, and explore immunologic, epidemiological and pharmacological activities confronting women living with HIV. This vision is operationalized in our multisite research proposal "The Emory SWEET Trial," an innovative implementable smartphone intervention designed to enhance antiretroviral adherence, promote harm reduction, reduce STDs incidence, and improve overall clinical and biomedical outcomes among HIV-infected and at-risk women. The site-specific projects engage the expertise of leading scientists at Emory to explore using the local WIHS cohort, the intracellular pharmacokinetics of commonly used antiretroviral drugs in HAART and PrEP, define the dyadic features that impact the lives of women living with HIV through couple voluntary counseling and HIV testing, and examine B cell subsets, PD- 1 expression, and serologic memory in peripheral blood and the female genital tract of HIV-infected women, to better characterize the impact of HIV infection on genital mucosal immunity.