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Phyllogney和接触跟踪以破坏HIV传播Kantor，Rami MD 概括 预防艾滋病毒传播仍然是全球的主要挑战，并且需要创新的方法 破坏。尽管实际的传输网络未知，但表征了社会和系统发育 网络可以指导预防干预措施。接触跟踪是当前推出社会的公共卫生工具 网络并识别，通知，测试并链接到新诊断的HIV病例的护理伙伴。系统发育 可用序列的分析在研究中用于表征发作，并准备了爆发 调查。但是，系统发育学的实时整合与接触涉及公共卫生，州 - 尚未评估广泛的水平。我们建议将系统发育分析与接触进行前瞻性地整合 实时追踪，并评估这种整合对罗德岛（RI）中HIV感染的影响。我们 假设从系统发育推断中实时使用信息可以增强接触追踪， 艾滋病毒测试，诊断和与护理的联系以及中断传播。具体目的是：（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 通过增加采样和更全面的测试； （3）评估实时集成的好处 系统发育学带有接触示意性的工作。我们将开发和自动化工具，以结合系统发育和 系统动力学推断，探索接触，探索其增强并评估其实时影响，并通过 特别考虑关键人群，例如与男性发生性关系的男人，静脉吸毒者和人 具有抗HIV耐药性。我们希望这种方法将改善身份和联系以照顾 受感染的个人，感染感知的个人与护理没有联系，未感染的人是 感染的高风险。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。如果我们的假设正确， 这项研究将对预防艾滋病毒和护理连续体和破坏艾滋病毒传播产生很大的影响 罗德岛。我们的研究方法的严谨性得到了我们的跨学科团队的加强， 公共卫生官员，统计学家，生物信息学家，进化论和分子生物学家，并结合我们 相关的现有数据和专业知识，国家的规模较小以及强大而近距离的学术公共 健康伙伴关系。此外，直接解决了重要和基本的道德考虑，并且 整个过程中合并。这种方法将使结果可概括和可持续，从而使人集中 资源分配以及调查结果的持续实施和概括。 2013年 RI卫生部宣布在下一个州内“达到零”的新艾滋病毒感染的愿景 五年，但是高风险网络之间的传播明显增加阻碍了进步。这 提案将有助于使小RI更接近其成为第一个进入新感染的州的目标，并且 证明专注力量如何防止RI及其他地区的艾滋病毒传播。