Identifying sources of HIV infection in adolescent girls in rural South Africa

确定南非农村少女的艾滋病毒感染源

• 批准号: 9273270
• 负责人: Ayesha BM Kharsany
• 金额: $ 34.02万
• 依托单位: CENTRE/AIDS PROGRAMME/RES/SOUTH AFRICA
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-07-09 至 2020-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9273270
• 关键词: AIDS prevention; Adolescent; Affect; African; Area; Automobile Driving; Behavior; Behavior Therapy; Behavioral; Bioinformatics; Biological; Characteristics; Clinic; Collaborations; Communities; Complex; Data; Data Collection; Diagnostic; Epidemic; Epidemiology; Equipment; Female Adolescents; Future; General Population; Genetic Variation; Geographic Locations; Geography; HIV; HIV Infections; HIV risk; HIV-1; HIV-infected adolescents; Health care facility; High-Throughput Nucleotide Sequencing; Incidence; Individual; Infection; Intervention; Link; Logit Models; Methodology; Methods; Pathway Analysis; Pattern; Phylogenetic Analysis; Population; Prevalence; Preventive Intervention; Recruitment Activity; Research; Research Design; Respondent; Risk; Risk Factors; Rural; Sampling; Schools; Selection Bias; Seroprevalences; Sex Behavior; Social Network; Source; South Africa; Surveys; System; Testing; Trees; Universities; Viral; Virus; Woman; Work; base; case control; design; high risk population; improved; innovation; insight; member; men; novel; public health relevance; rural South Africa; sexual HIV transmission; transmission process; virology

 DESCRIPTION (provided by applicant Adolescent girls in South Africa remain disproportionately affected by the HIV epidemic, despite the availability of several behavioural interventions to reduce the sexual transmission of HIV. Strategies to reduce HIV transmission in this key population would benefit greatly from a better understanding of the sexual networks that drive HIV transmission in adolescent girls. Furthermore, if HIV infection rates in adolescent girls can be reduced, this could break critical chains of transmission and decrease the spread of HIV in the general population. We hypothesise that complex sexual networks, including mixing between adolescents and community members, drive high HIV incidence in adolescent girls in rural South Africa. To test our hypothesis we will utilize an innovative approach to identify networks of HIV transmission that combine extensive epidemiologic sampling with phylogenetic analyses of HIV-1 sequence data and traditional sexual networking methods. Phylogenetic analysis has recently emerged as one of the most powerful and informative ways to use viral diversity to examine the underlying dynamics of HIV-1 transmission in affected populations. However, these methods have often failed to find linkages in endemic settings; this is likely due to underrepresentation because of sparse sampling of transmission pairs in large populations of HIV infected individuals. One of the major innovations of this proposal is identifying HIV-1 clusters and viral linkages in adolescents and link these to community sequences by extensively sampling HIV infected individuals from a defined geographic area (part of the sub-district of Vulindlela in KwaZulu-Natal), using several epidemiologic approaches to achieve a 'saturating' rate of population coverage. This area is uniquely suited for this research as the study area is rural and geographically well defined; it is one of the highest HIV burden districts in South Afric and CAPRISA has collected detailed data on the structural, behavioural and biological determinants of risks of HIV infection in this community over the last decade. Building on our expertise in HIV surveillance in this area we will i) enhance the representativeness of the phylogenetic analyses by combining novel recruitment strategies including clinic- and school-based recruitment, and respondent-driven sampling for hard-to-reach populations; ii) use high- throughput sequencing, and bioinformatics to identify HIV-1 transmission networks through HIV-1 viral linkages; and iii) include behavioural and biological information and other risk factors. This approach will allow us to characterize HIV transmission clusters and viral linkages in this hyper endemic region, analyze the contribution of HIV clusters to the new infections occurring among adolescent girls, and use this data to improve HIV prevention efforts in this key population for HIV control.

 南非的青春期女孩仍然受到艾滋病毒流行的不成比例的影响，尽管有几种行为干预措施可以减少艾滋病毒的性传播。减少这一关键人群中艾滋病毒传播的战略将极大地受益于更好地了解推动少女艾滋病毒传播的性网络。此外，如果青春期女孩的艾滋病毒感染率 如果能够减少，这可以打破关键的传播链，减少艾滋病毒在普通人群中的传播。我们假设，复杂的性关系网络，包括青少年和社区成员之间的混合，推动了南非农村少女艾滋病毒的高发病率。为了验证我们的假设，我们将利用一种创新的方法来识别艾滋病毒传播网络，该方法将广泛的流行病学采样与艾滋病毒-1序列数据的系统发育分析和传统的性网络方法相结合。最近，系统发育分析已经成为利用病毒多样性来研究艾滋病毒-1在受影响人群中传播的潜在动态的最强大和最有信息量的方法之一。然而，这些方法往往无法在流行环境中找到联系；这可能是由于在大量艾滋病毒感染者中对传播对进行稀疏抽样而导致代表性不足。这项建议的主要创新之一是确定青少年中的艾滋病毒-1聚集物和病毒联系，并通过从确定的地理区域(夸祖鲁-纳塔尔的Vulindlela分区的一部分)对艾滋病毒感染者进行广泛抽样，利用几种流行病学方法将这些与社区序列联系起来，以实现人口覆盖率的“饱和”。这一地区特别适合进行这项研究，因为研究地区是农村地区，地理上界定明确；它是南非艾滋病毒负担最重的地区之一，过去十年，非洲艾滋病方案收集了关于该社区艾滋病毒感染风险的结构、行为和生物决定因素的详细数据。基于我们在这一领域艾滋病毒监测方面的专门知识，我们将：(1)结合新颖的招募战略，包括诊所和学校招聘，以及对难以接触到的人群进行受访者驱动的抽样，提高系统发展分析的代表性；(2)利用高通量测序和生物信息学，通过艾滋病毒-1病毒联系查明艾滋病毒-1传播网络；(3)包括行为和生物信息及其他风险因素。这一方法将使我们能够确定这一高度流行地区的艾滋病毒传播聚集性和病毒联系的特征，分析艾滋病毒聚集性对少女新感染的贡献，并利用这些数据来改进这一艾滋病毒控制的关键人群的艾滋病毒预防工作。