Antimicrobial resistance in Neisseria gonorrhoeae among men on PrEP in Vietnam

项目摘要/摘要 抗菌素耐药性(AMR)是一个全球性的卫生紧急事件。淋球菌是一种高度优先的病原体。 对于AMR，因为全球每年有8700万人感染，而且这种细菌已经表现出对 每一类抗生素都推荐用于其治疗。有报道称治疗失败，通常涉及 口咽部感染，是无法治愈的淋病时代即将到来的可怕警告。在西部 太平洋地区，包括越南，对头孢曲松和阿奇霉素的耐药性最常见 建议使用抗生素治疗淋病的人数正在增加。男男性行为者(MSM)是 在淋病奈瑟菌感染中受到AMR的影响不成比例，但在来自低收入国家的数据中仍未得到充分代表 和中等收入国家(LMIC)。这项拟议的研究旨在更好地了解淋病奈瑟菌的AMR。 通过将新的研究嵌入到越南针对男男性接触者的现有艾滋病毒暴露前预防(PrEP)计划中。 本研究的目的是：1)确定男男性接触者中淋球菌AMR的患病率及其危险因素 在越南的一项PrEP计划中；2)测量咽部淋病治疗失败的频率 以及咽部感染和AMR之间的联系；以及3)使用全基因组测序(WGS) 进行淋病奈瑟菌的基因组流行病学研究。 在越南的预科项目。这项研究将利用对淋病奈瑟菌的定期检测和后续行动 通过PrEP计划，对这一关键人群中淋病奈瑟菌的AMR问题提供新的了解。 Fogarty国际研究科学家发展奖(K01)是为了支持职业发展 保罗·亚当森博士，一位传染病内科医生，他的目标是成为一个独立的全球卫生组织 AMR和性传播感染(STI)交叉点的调查员。K01将支持Dr。 亚当森将开发1)临床微生物学和AMR检测，2)WGS，生物信息学和基因组学方面的专业知识 流行病学，以及3)临床试验研究方面的高级培训，重点是LMICs。要实现建议的 研究和培训目标，亚当森博士组建了一支具有成熟经验的导师团队 职业生涯初期的研究人员，具有性传播感染、流行病学、AMR、生物统计学和基因组学方面的专业知识。戴维斯博士。 帕米娜·戈尔巴赫(UCLA)和黎明江(河内医科大学，HMU)将担任主要导师 并在性传播感染的大规模预防研究和临床试验方面拥有丰富的经验 和HIV在男男性接触者中的传播。此外，他的联合导师团队还包括杰弗里·克劳斯纳博士，他是一位驻美国的全球 卫生研究员、淋球菌STIs和AMR方面的国际专家，以及阮武仲博士， 一位在越南的研究人员，在临床微生物学和抗生素敏感性测试方面具有专业知识。 淋病。拟议的研究和培训目标利用强大的研究合作和 加州大学洛杉矶分校和HMU之间存在强大的研究基础设施。IRSDA将推动亚当森博士的职业生涯 作为性传播感染和AMR方面的专家，并确立他作为独立的全球卫生调查员的地位。

PROJECT SUMMARY/ABSTRACT Antimicrobial resistance (AMR) is a global health emergency. Neisseria gonorrhoeae is a high-priority pathogen for AMR, as there are 87 million infections per year worldwide and the bacteria has demonstrated resistance to every class of antibiotics recommended for its treatment. Treatment failures have been reported, typically involve oropharyngeal infections, and are dire warnings that the era of untreatable gonorrhea is near. In the Western Pacific Region, which includes Vietnam, resistance to ceftriaxone and azithromycin, the most commonly recommended antibiotic therapy for gonorrhea, are increasing. Men who have sex with men (MSM) are disproportionately affected by AMR in N. gonorrhoeae infections, but remain under-represented in data from low- and middle-income countries (LMICs). The proposed study seeks to better understand AMR in N. gonorrhoeae by embedding new research into an existing HIV pre-exposure prophylaxis (PrEP) program for MSM in Vietnam. The study aims are 1) to determine the prevalence of and risk factors for AMR in N. gonorrhoeae among MSM in a PrEP program in Vietnam; 2) to measure the frequency of pharyngeal N. gonorrhoeae treatment failures and the association between pharyngeal infections and AMR; and 3) to use whole-genome sequencing (WGS) to conduct a genomic epidemiology study of N. gonorrhoeae nested within our study population of MSM in a PrEP program in Vietnam. The study will leverage regular testing for N. gonorrhoeae and follow-up that occur through the PrEP program to shed new light on the issue of AMR in N. gonorrhoeae within this key population. This Fogarty International Research Scientist Development Award (K01) is to support the career development of Dr. Paul Adamson, an infectious diseases physician whose goal is to become an independent global health investigator at the intersection of AMR and sexually transmitted infections (STIs). The K01 will support Dr. Adamson to develop expertise in 1) clinical microbiology and AMR testing, 2) WGS, bioinformatics, and genomic epidemiology, and 3) advanced training in clinical trials research with a focus in LMICs. To achieve the proposed research and training aims, Dr. Adamson has assembled a mentorship team with proven experience mentoring early-career investigators and with expertise in STIs, epidemiology, AMR, biostatistics, and genomics. Drs. Pamina Gorbach (UCLA) and Le Minh Giang (Hanoi Medical University, HMU) will serve as Primary Mentors and have extensive experience in conducting large-scale prevention research studies and clinical trials on STIs and HIV among MSM. In addition, his Co-Mentorship team includes Dr. Jeffrey Klausner, a US-based global health researcher and an international expert on STIs and AMR in N. gonorrhoeae, and Dr. Nguyen Vu Trung, a Vietnam-based researcher with expertise in clinical microbiology and antibiotic susceptibility testing in N. gonorrhoeae. The proposed research and training aims leverage the strong research collaborations and the robust research infrastructure that exist between UCLA and HMU. The IRSDA will advance Dr. Adamson's career as an expert in STIs and AMR and establish him as an independent global health investigator.