Reaching Unaware Sexual and Social Contacts to Interrupt Ongoing HIV Transmission

描述（由申请人提供）：不知道自己感染艾滋病毒的人对持续的艾滋病毒传播的贡献不成比例。治疗即预防（TasP）取决于接触艾滋病毒感染者进行艾滋病毒检测和诊断，将他们与护理联系起来，并开始抗逆转录病毒治疗。如果大部分正在进行的传播与急性或近期HIV感染有关，TasP的有效性可能会降低，但急性HIV感染（AHI）提出了诊断挑战。识别AHI患者和近期感染者对于实现TasP的全部潜力可能至关重要。 在撒哈拉以南非洲，伴侣通知是一项未得到充分利用的战略，用于查明未确诊的艾滋病毒感染者。合同伴侣通知是一种具有成本效益的伴侣通知形式，新诊断的艾滋病毒感染者可在有限的时间内通知其性伴侣，然后由保健人员积极追踪。社会接触转介涉及转介同龄人进行艾滋病毒检测。这种方法的基本原理是，艾滋病毒感染者的社会接触者可能有类似的高危行为，从而增加了他们感染艾滋病毒的可能性。 我们的主要假设是：1）新发现的艾滋病毒感染性病门诊患者的伴侣通知和社会接触转介将有效地识别艾滋病毒感染但不知情的正在进行传播的高危人群，以及2）根据性行为、病毒载量和集群成员身份，艾滋病毒感染但不知情的性伴侣和急性和近期艾滋病毒感染者的社会接触将具有更大的艾滋病毒传播潜力，与慢性艾滋病毒感染者的不知情的性伴侣和社会接触者相比，我们将在马拉维的利隆圭讨论这些假设，有三个具体目标：目标1：评估“不知情的干预方案”，包括AHI检测、合同伴侣通知和社会接触转介，以发现不知道自己感染HIV的人;目标2：通过评估性行为、对艾滋病毒状况的认识、病毒载量，急性，近期和慢性感染艾滋病毒的性病诊所顾客和他们的性伴侣和社会接触者之间的系统发育聚类;目的3：评估潜在的AHI检测，合同合作伙伴的通知，和社会接触转介，以减少艾滋病毒的发病率使用数学建模。 为了实现这些目标，我们将在马拉维的两个性传播感染诊所招募艾滋病毒感染者。我们将评估结合AHI检测、合同伙伴通知和社会联系转介的无意识干预方案。我们将使用HIV血清学，HIV RNA PCR，多检测算法和探索性深度测序方法对Inde参与者，性伴侣和社会接触者的HIV感染进行分期。将对所有确定的感染进行系统发育连锁和聚类分析。将使用数学建模来评估这些干预措施对人口的潜在影响。

DESCRIPTION (provided by applicant): Persons unaware of their HIV infection contribute disproportionately to ongoing HIV transmission. Treatment as prevention (TasP) depends on reaching HIV-infected persons for HIV testing and diagnosis, linking them to care, and initiating antiretroviral therapy. TasP effectiveness may be reduced if a significant proportion of ongoing transmission is related to acute or recent HIV infection, but acute HIV infection (AHI) presents diagnostic challenges. Identifying persons with AHI and recent infection may be critical for the realization of the full potential of TasP. Partner notification is an underused strategy in sub-Saharan Africa to identify persons with undiagnosed HIV infection. Contract partner notification is a cost-efficient form of partner notification, in which newly diagnosed HIV-infected persons are given a limited time to notify their sexual partners, followed by active tracing by health personnel. Social contact referral involves referral of peers for HIV testing. The rationale for ths approach is that social contacts of HIV-infected persons are likely to share similar high-risk behaviors, thereby increasing their likelihood of HIV infection. Our central hypotheses are: 1) Partner notification and social contact referral of newly identified HIV- infected STI clinic patros will effectively identify HIV-infected-but-unaware persons at high risk for ongoing transmission, and 2) HIV-infected unaware sexual partners and social contacts of persons with acute and recent HIV infection will have greater potential for HIV transmission, based on sexual behavior, viral load, and cluster membership, than unaware sexual partners and social contacts of chronically HIV-infected persons. We will address these hypotheses in Lilongwe, Malawi with three specific aims: Aim 1: To evaluate an "unaware intervention package", including detection of AHI, contract partner notification, and social contact referral, to find persons unaware of thei HIV infection; Aim 2: To characterize the potential for ongoing HIV transmission through evaluation of sexual behaviors, awareness of HIV status, viral load, and phylogenetic clustering among acute, recent, and chronically HIV-infected STI clinic patrons and their sexual partners and social contacts; Aim 3: To assess the potential for AHI detection, contract partner notification, and social contact referral to reduce HIV incidence using mathematical modeling. To address these aims, we will recruit HIV-infected persons in two sexually transmitted infection clinics in Malawi. We will assess an unaware intervention package combining AHI detection, contract partner notification, and social contact referral. We will stage the HIV infection of inde participants, sexual partners and social contacts using HIV serology, HIV RNA PCR, a multi-assay algorithm, and an exploratory deep sequencing approach. Phylogenetic linkage and cluster analyses will be performed for all identified infections. Mathematical modeling will be used to assess the potential population-level impact of these interventions.