Real Time Phylogeny and Contact Tracing to Disrupt HIV Transmission

实时系统发育和接触者追踪以阻断艾滋病毒传播

• 批准号: 10097973
• 负责人: Rami Kantor
• 金额: $ 66.16万
• 依托单位: MIRIAM HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-03-05 至 2023-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10097973
• 关键词: AIDS prevention; Address; Awareness; Caring; Characteristics; Collaborations; Contact Tracing; Continuity of Patient Care; Data; Developed Countries; Development; Diagnosis; Disease Outbreaks; Drug resistance; Drug usage; Epidemic; Epidemiology; Ethics; Failure; Goals; Growth; Guide prevention; Guidelines; HIV; HIV Infections; HIV diagnosis; HIV drug resistance; Health; Human immunodeficiency virus test; Impact evaluation; Individual; Infection; Institution; Intravenous; Investigation; Lead; Link; Methodology; Methods; Modality; Molecular; Molecular Epidemiology; Newly Diagnosed; Outcome; Patients; Pattern; Persons; Phylogenetic Analysis; Phylogeny; Population; Prevention strategy; Public Health; Public Health Applications Research; Research; Resource Allocation; Resources; Rhode Island; Risk; Risk Behaviors; Sampling; Social Impacts; Social Network; Testing; Time; Vision; clinical care; disorder control; experience; follow-up; high risk; high risk behavior; improved; indexing; infection risk; innovation; intravenous drug user; men who have sex with men; multidisciplinary; novel; prevent; preventive intervention; prospective; social; standard of care; time use; tool; transmission process

Real Time Phylogeny and Contact Tracing to Disrupt HIV Transmission Kantor, Rami MD SUMMARY Prevention of HIV transmission is still a major global challenge, and innovative methods are needed for its disruption. Though actual transmission networks are unknown, characterizing social and phylogenetic networks can guide prevention interventions. Contact tracing is the current public health tool to derive social networks and identify, notify, test and link to care partners of newly-diagnosed HIV cases. Phylogenetic analysis of available sequences is used in research to characterize epidemics and has facilitated outbreak investigations. However, real time integration of phylogenetics with contact tracing on a public health, state- wide level has not been evaluated. We propose to prospectively integrate phylogenetic analysis with contact tracing in real time, and evaluate the impact of such integration on HIV infection in Rhode Island (RI). We hypothesize that real time use of information from phylogenetic inference can enhance contact tracing, improve HIV testing, diagnoses and linkage to care, and disrupt transmission. The Specific Aims are to: (1) Conduct real time phylogenetic analyses of patient-level sequence data; (2) Augment phylogenetic inference by increased sampling and more comprehensive testing; and (3) Evaluate the benefit of real time integration of phylogenetics with contact tracing efforts. We will develop and automate tools to incorporate phylogenetic and phylodynamic inference into contact tracing, explore its enhancement, and evaluate its real time impact, with special consideration of key populations like men who have sex with men, intravenous drug users and persons with HIV drug resistance. We expect that this approach will improve identification and linkage to care of infected-unaware individuals, infected-aware individuals not linked to care, and uninfected individuals that are at high risk of infection. The main premise of this proposal is that phylogenetic networks contain information which can expand social networks and impact HIV transmission. If our hypothesis is correct, this research will have high impact on HIV prevention and the care continuum and disrupt HIV transmission in Rhode Island. The rigor of our research approach is strengthened by our multidisciplinary team of clinicians, public health officials, statisticians, bioinformaticians, evolutionary and molecular biologists, combined with our relevant existing data and expertise, the small size of the state and the strong and close academic-public health partnership. Furthermore, important and essential ethics considerations are directly addressed and incorporated throughout. Such an approach will make results generalizable and sustainable, allowing focused resource allocation and continuous implementation and generalization of findings. In 2013 the Director of the RI Department of Health declared the vision of ‘Getting to Zero’ new HIV infections in the state within the next five years, however apparent increases in transmission among high risk networks has impeded progress. This proposal will help bring small RI closer to its goal of being the first state to get to zero new infections and demonstrate how focusing efforts can prevent HIV transmission in RI and beyond.

实时系统发育和接触者追踪以破坏艾滋病毒传播 Kantor，Rami MD 概括 预防艾滋病毒传播仍然是全球面临的重大挑战，需要创新方法 扰乱。尽管实际的传播网络尚不清楚，但描述了社会和系统发育的特征 网络可以指导预防干预措施。接触者追踪是当前获取社会信息的公共卫生工具 网络并识别、通知、测试新诊断的艾滋病毒病例并与护理伙伴建立联系。系统发育 对可用序列的分析用于研究来表征流行病并促进了爆发 调查。然而，系统发育学与接触者追踪对公共卫生、国家的实时整合 宽级别尚未评估。我们建议前瞻性地将系统发育分析与接触相结合 实时追踪，并评估这种整合对罗德岛州 (RI) 艾滋病毒感染的影响。我们 假设实时使用系统发育推断信息可以增强接触者追踪， 改善艾滋病毒检测、诊断和护理联系，并阻断传播。具体目标是： (1) 对患者级序列数据进行实时系统发育分析； (2) 增强系统发育推断 通过增加抽样和更全面的测试； (3) 评估实时集成的效益 系统发育与接触者追踪工作。我们将开发和自动化工具来整合系统发育和 对接触者追踪进行系统动力学推断，探索其增强功能，并评估其实时影响， 特别考虑重点人群，如男男性行为者、静脉注射吸毒者和个人 与艾滋病毒耐药性。我们期望这种方法将改善护理的识别和联系 不知道被感染的个人、与护理无关的知道被感染的个人以及未接受护理的个人 感染风险很高。该提议的主要前提是系统发育网络包含 可以扩大社交网络并影响艾滋病毒传播的信息。如果我们的假设是正确的 这项研究将对艾滋病毒预防和护理连续性产生重大影响，并阻止艾滋病毒传播 罗德岛。我们的多学科临床医生团队加强了我们研究方法的严谨性， 公共卫生官员、统计学家、生物信息学家、进化和分子生物学家，以及我们的 相关的现有数据和专业知识、国家规模较小以及强大而密切的学术公共 健康伙伴关系。此外，直接解决了重要和基本的道德考虑因素， 贯穿始终。这种方法将使结果具有普遍性和可持续性，从而能够集中精力 资源分配以及持续实施和推广研究结果。 2013年，担任董事 罗德岛州卫生部宣布，该州的新艾滋病感染率将在未来几年内“达到零” 然而，五年来，高风险网络之间传播的明显增加阻碍了进展。这 该提案将有助于小型RI更接近成为第一个实现零新增感染的州的目标 展示集中努力如何预防罗德岛州及其他地区的艾滋病毒传播。