Revealing women's hidden role as critical components of HIV transmission networks in Rakai, Uganda: an interdisciplinary approach

揭示乌干达拉凯妇女作为艾滋病毒传播网络关键组成部分的隐藏作用：跨学科方法

• 批准号: 9242563
• 负责人: Mary Kathryn Grabowski
• 金额: $ 12.79万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-03-15 至 2021-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9242563
• 关键词: AIDS prevention; Abate; Acquired Immunodeficiency Syndrome; Africa South of the Sahara; African; Behavior; Behavioral; Behavioral Sciences; Characteristics; Clinical; Cohort Studies; Communities; Data; Effectiveness; Effectiveness of Interventions; Emergency Situation; Epidemic; Epidemiologic Methods; Epidemiology; Female; Fishes; Frequencies; Future; Gender; Geographic Locations; Gifts; HIV; HIV Infections; HIV risk; High Prevalence; High Risk Woman; Human immunodeficiency virus test; Incidence; Individual; Infection; Intervention; Interview; Length; Link; Low Prevalence; Measures; Mentored Research Scientist Development Award; Methods; Modeling; Occupations; Participant; Phase; Phylogenetic Analysis; Phylogeny; Population; Population Study; Predisposition; Prevalence; Prevention; Prevention strategy; Qualitative Methods; Qualitative Research; Reporting; Research; Research Methodology; Research Personnel; Research Training; Risk; Risk Assessment; Risk Behaviors; Risk Factors; Role; Rural; Sex Behavior; Source; Statistical Models; Subgroup; Surveys; Training; Uganda; Viral; Viral Load result; Woman; Work; antiretroviral therapy; base; data format; demographics; epidemiologic data; epidemiology study; high risk; improved; insight; interdisciplinary approach; knowledge base; male; men; novel; pre-exposure prophylaxis; prevent; primary outcome; public health relevance; scale up; sex; social stigma; success; transmission process

 DESCRIPTION (provided by applicant): The burden of HIV is ~60% higher in women than men in sub-Saharan Africa, and this gender inequity is a key challenge to HIV control. Identifying women at greatest risk for HIV and their infecting male partners is critical for effective, targeted control of the African HIV epidemic. It is also vital to identify those HIV-infected women most likely to contribute to ongoing viral spread. However, African women vastly underreport sexual contacts and high risk occupations such as sex work in interview-based surveys and clinical settings making their identification challenging. Here, we propose to use phylogenetic, epidemiological, and qualitative methods to study network drivers of female risk of HIV acquisition and onward transmission to men in the rural Rakai District, Uganda. We will use existing data from the Rakai Community Cohort Study (RCCS), a population- based study of HIV incidence and behaviors in 50 communities (n~17,000). In Aim 1 we will identify HIV- infected women who have central roles in transmission networks using viral phylogenetics and then characterize them with RCCS epidemiological data. We will also conduct in-depth interviews with these women to gain deeper insight into their HIV-related risks and to understand the barriers to reporting these risks. In Aim 2 we will use viral phylogenetics in conjunction with probabilistic statistical models to identify the pool of infecting male partners tat sustain the excess HIV burden among Rakai women. Lastly, in Aim 3 we will use microsimulation models to estimate the potential effectiveness of various combination HIV prevention strategies targeted to high risk subgroups to reduce HIV incidence. The proposed research is part of a K01 award and will provide the applicant with the advanced training in HIV modelling, behavioral science, and phylogenetics necessary to transition to an independent investigator with expertise in the application of interdisciplinary methods to HIV epidemiology and prevention. Results will improve female HIV risk assessment and identify candidate targeted strategies to prevent HIV in African women. It also will provide critical formative data fr a future R01 to implement and empirically assess the effectiveness of targeted interventions to high risk women and their partners in Rakai.

 描述（由申请人提供）：在撒哈拉以南非洲，女性艾滋病毒负担比男性高约60%，这种性别不平等是艾滋病毒控制的一个关键挑战。查明艾滋病毒风险最大的妇女及其感染艾滋病毒的男性伴侣，对于有效、有针对性地控制非洲艾滋病毒流行至关重要。还必须查明那些最有可能助长病毒持续传播的感染艾滋病毒的妇女。然而，在基于访谈的调查和临床环境中，非洲妇女大大低估了性接触和高风险职业，如性工作，使其识别具有挑战性。在这里，我们建议使用系统发育，流行病学和定性的方法来研究网络驱动器的女性艾滋病毒感染的风险，并在农村的Rakai区，乌干达的男性传播。我们将使用来自Rakai社区队列研究（RCCS）的现有数据，RCCS是一项基于50个社区（n~ 17，000）的HIV发病率和行为的人群研究。在目标1中，我们将使用病毒遗传学方法确定在传播网络中发挥核心作用的艾滋病毒感染妇女，然后使用RCCS流行病学数据描述她们的特征。我们还将对这些妇女进行深入访谈，以更深入地了解她们的艾滋病毒相关风险，并了解报告这些风险的障碍。在目标2中，我们将使用病毒遗传学结合概率统计模型，以确定在Rakai妇女中维持过度艾滋病毒负担的感染男性伴侣库。最后，在目标3中，我们将使用微观模拟模型来评估针对高危亚群的各种艾滋病毒预防组合策略的潜在有效性，以降低艾滋病毒的发病率。拟议的研究是K 01奖的一部分，将为申请人提供艾滋病毒建模，行为科学和遗传学方面的高级培训，以便过渡到具有跨学科方法应用于艾滋病毒流行病学和预防的专业知识的独立研究者。研究结果将改善女性艾滋病毒风险评估，并确定预防非洲妇女感染艾滋病毒的候选目标战略。它还将为未来的R 01提供关键的形成性数据，以实施和经验评估针对Rakai高风险妇女及其伴侣的有针对性的干预措施的有效性。