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: 9126802
• 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/9126802
• 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(由申请者提供)：本申请申请资金，用于开展大规模以人群为基础的寻找、测试、治疗和保留(STTR)倡议的创新研究。加拿大不列颠哥伦比亚省启动了世界上规模最大、最先进的科技创新举措之一，并于2012年11月更新了该举措。该省的全民医疗系统免费提供所有医疗服务，包括高效抗逆转录病毒疗法(HAART)和药物滥用治疗。广泛的保密记录链接可以准确地实现所有关键措施，包括卫生服务利用率和艾滋病毒临床结果。利用这一倡议和大型链接数据库，以及不列颠哥伦比亚省艾滋病毒/艾滋病卓越研究中心(温哥华)的跨学科研究能力，我们在此提出了一个严谨和创新的研究计划，该计划将整合流行病学、临床、地理和系统发生学方法，为应对艾滋病毒感染个人中的艾滋病毒传播和发病机制提供关键信息，特别是针对注射毒品的个人(IDU)。具体地说，我们试图通过基于分子遗传学和地理信息系统(GIS)的方法来加强我们正在进行的流行病学和临床研究活动，以模拟这一STTR倡议对产生抗逆转录病毒耐药性和艾滋病毒发病率的影响。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宜性。为了帮助优化STTR方法，我们还将确定IDU参与和泄漏的模式和预测因素。最后，通过将地理信息系统与系统发育数据相结合，我们将在全省范围内确定未识别的艾滋病毒传播源。这项建议提出之际，国际社会一致认为有必要紧急应对艾滋病毒相关发病率和死亡率上升的问题，特别是在注射吸毒者中。来自数学建模、观察性队列和临床试验的证据表明，获得HAART与艾滋病毒在个人之间传播的风险之间存在密切联系，从而导致HAART覆盖率较高的人群的感染率显著降低。这一观察结果导致了新的艾滋病毒预防努力，以寻找弱势群体成员，对他们进行艾滋病毒感染检测，并让他们参与医疗保健，包括艾滋病毒感染的治疗，以减少与艾滋病毒相关的发病率和死亡率，降低艾滋病毒发病率。鉴于迄今已建立的研究基础设施，以及我们在开展新的和高影响的STTR研究方面的记录，我们处于独特的有利地位，能够前瞻性地评估STTR对参与治疗和护理、HAART耐药性和艾滋病毒发病率的关键第二代问题。这里提议的工作与2013财年艾滋病毒相关研究跨NIH计划中的优先事项密切相关。