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.

项目总结 目前的估计是，美国57%的艾滋病毒携带者受到抑制，43%的人没有受到抑制， 包括约13%的未确诊患者和30%已确诊但目前未确诊的患者 被压制了。识别未受抑制的艾滋病毒携带者，将他们与护理和抗逆转录病毒治疗联系起来(抗逆转录病毒治疗) 对于改善健康和减少新感染至关重要。新的流行病学工具，实时识别 艾滋病毒大量传播的社区可能会加强努力，减少艾滋病毒的传播和 在很大程度上有助于结束艾滋病毒流行。在SARS-CoV-2(SCV2)大流行期间，我们和其他人 运用“废水环境病毒学”监测和应对新城疫。它使用病毒捕获和聚合酶链式反应 从废水收集点检测病毒核酸以检测、定量和预测总SCV2 及时开展活动。我们为休斯顿地区建立了一个强大和成熟的废水采样计划， 包括对覆盖约400万居民的39个废水收集点进行每周评估。我们最近 初步数据表明，在废水中检测到艾滋病毒。废水检测是公正的， 全面、实时、量化，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计划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较高的地理区域，反映出相当数量的艾滋病毒携带者 未诊断或未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 艾滋病毒外展、检测、预防和与护理的联系。具体目标是：1)开发一种敏感的、 可重复性的、流线型的废水艾滋病毒检测管道；2)开发流行病学模型 将来自废水采样的数据作为一个新的和信息丰富的参数与常规一起纳入 关于艾滋病毒诊断和人口数据的监测数据；3)确定和纳入利益攸关方 让关键的社区利益相关者参与艾滋病毒废水的偏好、优先事项和建议 抽样计划，考虑到生活在 以社区为目标；4)确定是否向社区提供经过验证的公共卫生干预措施 由废水数据指导，可以减少废水病毒载量，增加这些人的艾滋病毒诊断 邻里关系。这项研究将加强结束艾滋病毒流行(EHE)战略的应对支柱。它 将利用并加强研究人员与休斯顿卫生部之间的伙伴关系， 地区公共卫生当局在休斯顿监督许多EHE项目。在休斯顿的工作，一种很高的 优先地区，将导致：(I)美国唯一的艾滋病毒废水采样计划，(Ii)流行病学模型 加强废水数据，以确定未得到满足的测试和处理需求；(3)社区知情和 道德上适当的实时公共卫生监测，减少未受抑制的人数 以及(4)可传播到其他领域的工具和专门知识。