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Rapid Response to Incident HIV Infection through Social Network Strategies and Molecular Epidemiology to Inform Partner Services

通过社交网络策略和分子流行病学快速响应艾滋病毒感染事件，为合作伙伴服务提供信息

基本信息

批准号：
10653195
负责人：
Ann Dennis
金额：
$ 71.97万
依托单位：
UNIV OF NORTH CAROLINA CHAPEL HILL
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-07-01 至 2027-06-30
项目状态：
未结题

项目摘要

PROJECT SUMMARY The objective of the proposed research is to improve the response to incident HIV infection by engaging the networks of Black men who have sex with men (BMSM) and transgender women (TGW) through a combination of Partner Services, social network recruitment, and HIV genetic cluster detection. Despite marked advances in HIV treatment and prevention, HIV incidence has not substantially declined among BMSM/TGW in the Southern United States (US), highlighting the need for innovative methods to detect and respond to ongoing HIV transmission. While Partner Services can be highly effective, case finding remains limited even for persons diagnosed soon after HIV acquisition (acute or recent infections). Partner Services can also be limited in investigations across jurisdictional boundaries and in rural areas. We hypothesize that leveraging the social networks (social contacts rather than only drug sharing or sexual partners) of networks with recent HIV transmission will lead to improved engagement in HIV services (prevention or care). However, such strategies must be responsive to the barriers and facilitators to engagement in these services including a better understanding of social support networks. This project involves a multidisciplinary team including robust public health partnerships and active community engagement to address HIV prevention needs and build on existing resources. We will develop and implement an enhanced social network strategy (eSNS) for networks of BMSM/TGW with new HIV diagnoses, including acute incident infection, in the high-burden Charlotte region (Mecklenburg County, North Carolina), situated on the border of South Carolina. Both areas are priority regions in the Ending the Epidemic (EHE) initiative. In the eSNS intervention, new diagnoses will receive rapid response Partner Services for elicitation of social and sexual contacts; selected contacts will be recruited and coached to recruit their peers to engage in HIV services. Aim 1 will employ regional genetic and contact network analysis of incident and prevalent HIV in North and South Carolina, to evaluate important connections (bridging) between states and between urban and rural areas. This granular data (contact, spatial, genetic) will expand epidemiological understanding of the epidemic to inform development of the eSNS and enhance local EHE strategies. To further inform eSNS development, Aim 2 will use a mixed methods approach to examine the barriers and facilitators of engaging BMSM/TGW members of networks with recent HIV transmission. Aim 3 will then evaluate the eSNS with effectiveness and implementation outcomes. Effectiveness outcomes (increase in testing, pre-exposure prophylaxis referral, and HIV care engagement) will be evaluated with regression point displacement design comparing outcomes pre/post intervention in Charlotte and in comparison, with the Raleigh region receiving standard of care partner services. Overall, the results of this project will lead to critical information to guide new strategies in Partner Services and in EHE responses to increase HIV care and prevention engagement among BMSM/TGW in the Southern US.

项目概要拟议研究的目的是通过让通过一个由与男性发生性关系的黑人男性 (BMSM) 和变性女性 (TGW) 组成的网络合作伙伴服务、社交网络招募和 HIV 基因簇检测的结合。尽管艾滋病毒治疗和预防取得显着进展，艾滋病毒感染率并未大幅下降美国南部 (US) 的 BMSM/TGW，强调需要创新方法来检测和应对持续的艾滋病毒传播。虽然合作伙伴服务非常有效，但案例查找仍然存在即使对于艾滋病毒感染后不久被诊断出的人（急性或近期感染）也是有限的。合作伙伴服务跨司法管辖区边界和农村地区的调查也可能受到限制。我们假设利用网络的社交网络（社交联系而不仅仅是药物共享或性伴侣）最近的艾滋病毒传播将导致人们更好地参与艾滋病毒服务（预防或护理）。然而，此类战略必须应对参与这些服务的障碍和促进因素，包括更好地了解社会支持网络。该项目涉及一个多学科团队，其中包括强大的公共卫生伙伴关系和积极的社区参与，以满足艾滋病毒预防需求并在此基础上现有资源。我们将为网络制定并实施增强型社交网络战略（eSNS）高负担夏洛特地区 BMSM/TGW 新增艾滋病毒诊断，包括急性感染事件（北卡罗来纳州梅克伦堡县），位于南卡罗来纳州边境。这两个地区都是优先地区参与“结束流行病”（EHE）倡议。在eSNS干预下，新的诊断将得到快速响应合作伙伴服务以引发社交和性接触；将招募选定的联系人，并指导招募同伴参与艾滋病毒服务。目标 1 将利用区域遗传和联系对北卡罗来纳州和南卡罗来纳州的艾滋病毒事件和流行情况进行网络分析，以评估重要的联系（桥接）州与州之间以及城市与农村地区之间。这些颗粒数据（接触、空间、遗传）将扩大对这一流行病的流行病学了解，为 eSNS 的发展提供信息，并加强当地 EHE 策略。为了进一步为 eSNS 开发提供信息，目标 2 将使用混合方法来检查使 BMSM/TGW 成员参与最近艾滋病毒传播的网络的障碍和促进因素。目的 3 然后将评估 eSNS 的有效性和实施结果。有效性结果（检测、暴露前预防转诊和艾滋病毒护理参与度的增加）将通过回归点位移设计比较夏洛特和美国干预前/后的结果相比之下，罗利地区接受标准的护理合作伙伴服务。总的来说，本次的结果项目将产生关键信息，以指导合作伙伴服务和 EHE 应对措施的新战略提高美国南部 BMSM/TGW 的艾滋病毒护理和预防参与度。