Wastewater Sampling: A New Tool to Accelerate Ending the HIV Epidemic

废水采样：加速结束艾滋病毒流行的新工具

• 批准号: 10762555
• 负责人: Thomas P Giordano
• 金额: $ 77.68万
• 依托单位: BAYLOR COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-15 至 2028-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10762555
• 关键词: 2019-nCoV; Acceleration; Area; Authorization documentation; Bioethics Consultants; COVID-19; COVID-19 monitoring; COVID-19 outbreak; COVID-19 pandemic; Caring; Clinical Data; Collection; Communities; Complex; Data; Data Reporting; Detection; Diagnosis; Diagnostic; Diagnostic tests; Disease Outbreaks; Epidemic; Epidemiologist; Epidemiology; Ethics; Geographic Locations; Geography; HIV; HIV Infections; HIV diagnosis; Health; Human; Human immunodeficiency virus test; Individual; Infection; Laboratories; Link; Methods; Monitor; Neighborhoods; Nose; Nucleic Acids; Periodicals; Persons; Physicians; Plants; Poliomyelitis; Population; Prevention; Public Health; Recommendation; Reporting; Reproducibility; Research; Research Personnel; Resolution; Resources; Sewage; Sexual Partners; Signal Transduction; Site; Testing; Time; Viral; Viral Load result; Work; antiretroviral therapy; authority; coronavirus disease; epidemiological model; ethical, legal, and social implication; experience; health care availability; improved; novel; novel strategies; outreach; predictive modeling; preference; programs; public health intervention; routine care; sewage treatment; social stigma; success; surveillance data; tool; transmission process; viral detection; virology; wastewater sampling; wastewater testing

PROJECT SUMMARY Current estimates are that 57% of persons in the U.S. with HIV are suppressed, leaving 43% unsuppressed, including about 13% who are undiagnosed and 30% who have been diagnosed but are not currently suppressed. Identifying persons with unsuppressed HIV to link them to care and antiretroviral treatment (ART) is critical for improving health and reducing new infections. New epidemiologic tools that identify in real time communities with high amounts of circulating HIV may enhance efforts to reduce HIV transmission and substantially contribute to ending the HIV epidemic. During the SARS-CoV-2 (SCV2) pandemic, we and others used “wastewater environmental virology” to monitor and respond to COVID. It uses viral capture and PCR detection of viral nucleic acid from wastewater collection sites to detect, quantify, and predict total SCV2 activity in time. We built a robust and mature wastewater sampling program for the Houston region that includes weekly assessment of 39 wastewater collection sites covering about 4 million residents. Our recent preliminary data demonstrate that HIV is detected in wastewater. Wastewater testing is unbiased, comprehensive, real-time, quantitative, and not influenced by access to health care, stigma or denial. We hypothesize that our pioneering wastewater sampling program can be applied as a powerful new tool to identify geographic areas with a high active burden of HIV, reflecting substantial numbers of people with undiagnosed or untreated HIV infection. Resources can then be mobilized to these communities to enhance HIV outreach, testing, prevention and linkage to care. The specifics aims are: 1) To develop a sensitive, reproducible, and streamlined wastewater HIV detection pipeline; 2) To develop epidemiologic models incorporating data from wastewater sampling as a novel and informative parameter along with routine surveillance data on HIV diagnoses and population data; 3) To characterize and incorporate stakeholder preferences, priorities, and recommendations for engaging key community stakeholders in the HIV wastewater sampling program with consideration to the ethical, legal, social, and cultural contexts of individuals living in target neighborhoods; 4) To determine if delivering proven public health interventions to neighborhoods as directed by wastewater data can reduce the wastewater viral load and increase HIV diagnoses in those neighborhoods. This research will enhance the Respond pillar of the End the HIV Epidemic (EHE) strategy. It will leverage and strengthen partnerships between the researchers and the Houston Health Department, the regional public health authority overseeing many EHE programs in Houston. The work in Houston, a high priority EHE region, will result in: (i) the US’s only HIV wastewater sampling program, (ii) epidemiologic models enhanced with wastewater data that identify unmet testing and treatment needs, (iii) community-informed and ethically appropriate, real-time public health monitoring that reduces the number of people with unsuppressed HIV, and (iv) tools and expertise that can be disseminated to other areas.

项目概要 目前估计，美国 57% 的艾滋病毒感染者受到抑制，而 43% 的艾滋病毒感染者未受到抑制， 其中约 13% 未确诊，30% 已确诊但目前尚未确诊 压制。识别未受抑制的艾滋病毒感染者，将他们与护理和抗逆转录病毒治疗 (ART) 联系起来 对于改善健康和减少新感染至关重要。实时识别的新流行病学工具 艾滋病毒传播量大的社区可以加强努力减少艾滋病毒传播和 为结束艾滋病毒流行作出重大贡献。在 SARS-CoV-2 (SCV2) 大流行期间，我们和其他人 使用“废水环境病毒学”来监测和应对新冠病毒。它使用病毒捕获和 PCR 检测废水收集点的病毒核酸，以检测、量化和预测总 SCV2 及时活动。我们为休斯顿地区建立了强大且成熟的废水采样计划 包括对覆盖约 400 万居民的 39 个废水收集站进行每周评估。我们最近的 初步数据表明，废水中检测到了艾滋病毒。废水测试是公正的， 全面、实时、定量，并且不受获得医疗保健、耻辱或拒绝的影响。我们 假设我们开创性的废水采样程序可以作为一种强大的新工具应用于 确定艾滋病毒活跃负担高的地理区域，反映大量艾滋病毒感染者 未经诊断或未经治疗的艾滋病毒感染。然后可以向这些社区调动资源，以增强 艾滋病毒宣传、检测、预防以及与护理的联系。具体目标是： 1）培养敏感、 可重复且简化的废水 HIV 检测管道； 2）建立流行病学模型 将废水采样数据作为新颖且信息丰富的参数与常规参数结合起来 关于艾滋病毒诊断和人口数据的监测数据； 3) 描述和纳入利益相关者 让主要社区利益相关者参与艾滋病毒废水处理的偏好、优先事项和建议 抽样计划考虑到生活在其中的个人的道德、法律、社会和文化背景 目标社区； 4) 确定向社区提供行之有效的公共卫生干预措施是否符合 由废水数据指导可以减少废水病毒载量并增加艾滋病毒诊断 社区。这项研究将增强终结艾滋病毒流行 (EHE) 战略的应对支柱。它 将利用和加强研究人员与休斯顿卫生局之间的合作关系 地区公共卫生当局负责监督休斯顿的许多 EHE 项目。在休斯敦的工作，一个高 优先 EHE 地区，将产生：(i) 美国唯一的 HIV 废水采样计划，(ii) 流行病学模型 通过废水数据来增强，以确定未满足的测试和处理需求，(iii) 社区知情和 道德上适当的实时公共卫生监测，可减少未受抑制的人数 艾滋病毒，以及 (iv) 可以传播到其他领域的工具和专业知识。