Integrating Assisted Partner Services and Phylogenetics for HIV and HCV Prevention

摘要 为了控制肯尼亚和撒哈拉以南非洲其他地区的艾滋病毒流行， 和治疗注射毒品的艾滋病毒感染者至关重要。同样重要的是， 如果预防和治疗方案要得到更好的理解， 为主要受影响人群提供大规模服务。该研究将由Carey Farquhar博士和约书亚博士共同领导 Herbeck是华盛顿大学，肯雅塔国立医院， 夸祖鲁-纳塔尔大学、肯尼亚卫生部和一个地方非政府组织，支持预防吸毒和 非洲治疗方案。这项研究将确定是否协助艾滋病毒感染者PWID通知他们的 合作伙伴可以是一个成功的战略，艾滋病毒检测和联系，以照顾，以及是否协助伙伴 通知服务（APS）可用于识别丙型肝炎（HCV）高危个体。主 目的是确定每个艾滋病毒感染者有多少共用针头和性伴侣获得艾滋病毒 检测服务可以检测，诊断HIV或HCV阳性，与适当的服务相关联，并参与 测试后3个月的护理。为了实现这一目标，在APS经验丰富的健康顾问将招募和登记1000人 艾滋病毒感染者在内罗毕马萨雷贫民区的3个针头注射器方案诊所。连同 来自SAPTA的同伴教育者、研究健康顾问将告知合作伙伴HIV和HCV的暴露情况， 安排在诊所或其他地点进行测试。这种策略尚未用于艾滋病毒或HCV的PWID， 然而，最近的研究表明，在肯尼亚的一般人群中，这种方法是可以接受和可行的。我们 第二个和第三个目标是利用APS的能力来识别新的HIV和HCV病例，并利用遗传学来 描述这一关键人群中HIV和HCV持续传播的传播方式和风险因素。 将从网络中的1000名HIV感染者和1000名HCV感染者的PWID中收集滤纸上的血点 艾滋病病毒和丙型肝炎病毒将在夸祖鲁-纳塔尔大学研究实验室进行测序。这种类型的 分子流行病学方法尚未用于该人群的HIV或HCV，但具有很大的前景 当与社会人口统计学和行为数据的收集相结合时， 对这两种病毒的进一步传播起着重要作用。我们预计，我们的结果将塑造 肯尼亚和撒哈拉以南非洲未来预防工作的成功，使公共卫生计划， 针对高风险群体，这反过来将为更深入地研究有效的筛查铺平道路， 服务交付PWID。

ABSTRACT To contain the HIV epidemic in Kenya and other parts of sub-Saharan Africa, innovative strategies for identifying and treating HIV-infected persons who inject drugs (PWID) are critically important. It is also essential that factors contributing to onward transmission are better understood if prevention and treatment programs are to be brought to scale for key affected populations. The study will be co-led by Dr. Carey Farquhar and Dr. Joshua Herbeck and is a collaborative effort between the University of Washington, Kenyatta National Hospital, the University of Kwa-Zulu-Natal, Kenya Ministry of Health and a local NGO, Support for Addiction Prevention and Treatment in Africa (SAPTA). The study will determine whether assisting HIV-infected PWID to notify their partners can be a successful strategy for HIV testing and linkage to care, and whether assisted partner notification services (APS) can be leveraged to identify individuals at high risk for hepatitis C (HCV). The primary objective is to determine how many needle-sharing and sexual partners per HIV-infected PWID accessing HIV testing services can be tested, diagnosed HIV- or HCV-positive, linked to appropriate services, and engaged in care at 3 months post-testing. To achieve this, health advisors experienced in APS will recruit and enroll 1000 HIV-infected participants at 3 needle-syringe program clinics in the Mathare slum area of Nairobi. Together with peer educators from SAPTA, study health advisors will inform partners of the exposure to HIV and HCV and arrange for testing at the clinic or another venue. This strategy has not been used among PWID for HIV or HCV, however, it has recently been shown to be acceptable and feasible in the general population in Kenya. Our second and third aims leverage the ability of APS to identify new HIV and HCV cases and use phylogenetics to characterize modes of transmission and risk factors for ongoing HIV and HCV transmission in this key population. Blood spots will be collected on filter paper from 1000 HIV-infected and 1000 HCV-infected PWID in the network and HIV and HCV will be sequenced at the University of KwaZulu-Natal research laboratory. This type of molecular epidemiology approach has not been used in this population for HIV or HCV and holds great promise when combined with collection of sociodemographic and behavioral data for defining population level factors contributing significantly to onward transmission of these two viruses. We anticipate that our results will shape the success of future prevention efforts in Kenya and sub-Saharan Africa by enabling public health programs to target high-risk clusters, and this will in turn pave the way for more in-depth research on effective screening and service delivery PWID.