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传播艾滋病毒的贡献不成比例。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。如果正在进行的传播中有很大一部分与急性或最近的艾滋病毒感染有关，则TasP的有效性可能会降低，但急性艾滋病毒感染（AHI）提出了诊断挑战。识别患有AHI和近期感染的患者对于充分发挥TasP的潜力至关重要。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，以确定未确诊的艾滋病毒感染者。合同伴侣通知是一种成本效益高的伴侣通知形式，新诊断的艾滋病毒感染者在有限的时间内通知其性伴侣，然后由卫生人员积极追踪。社会接触转介包括转介同伴进行艾滋病毒检测。这种做法的理由是，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。我们的中心假设是：1)对新发现的艾滋病毒感染的性传播感染门诊巡查人员的伴侣通知和社会接触转诊将有效地识别出艾滋病毒感染但不知情的高危持续传播者；2)基于性行为、病毒载量和聚类成员，急性和近期艾滋病毒感染者的不知情的性伴侣和社会接触者将有更大的艾滋病毒传播潜力。慢性艾滋病毒感染者不知情的性伴侣和社会接触者我们将在马拉维的利隆圭解决这些假设，有三个具体目标：目标1：评估“不知情干预一揽子计划”，包括AHI检测、合同伙伴通知和社会接触转介，以发现不知道自己感染艾滋病毒的人；目的2：通过评估急性、近期和慢性艾滋病毒感染的性传播感染门诊顾客及其性伴侣和社会接触者的性行为、对艾滋病毒状况的认识、病毒载量和系统发育聚类，来描述正在进行的艾滋病毒传播的可能性；目的3：利用数学模型评估AHI检测、合同伙伴通知和社会接触转诊降低HIV发病率的潜力。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。我们将评估一种不知情的干预方案，包括AHI检测、合同伙伴通知和社会联系推荐。我们将使用HIV血清学、HIV RNA PCR、多分析算法和探索性深度测序方法对受试者、性伴侣和社会接触者进行HIV感染分期。将对所有确定的感染进行系统发育连锁和聚类分析。将使用数学模型来评估这些干预措施对人口水平的潜在影响。

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.