Integrating Assisted Partner Services and Phylogenetics for HIV and HCV Prevention

摘要 在撒哈拉以南非洲和全球，许多注射毒品者患有未确诊或 未经治疗的艾滋病毒感染者，经历着严重的贫困、粮食和住房不稳定以及歧视， 健康状况的风险增加，导致COVID-19的结果更糟。也更具挑战性 当服务受到封锁和确保社会福利措施的限制时， 保持距离，以防止呼吸道病毒的传播，如SARS-CoV-2。我们建议招聘和遵循一个 500名HIV阳性和500名HIV阴性PWID及其伴侣的队列，其中许多人也患有丙型肝炎， 确定艾滋病毒感染控制不佳、积极吸毒和其他艾滋病毒和艾滋病特异性风险 因素导致COVID-19感染、病毒传播、症状性疾病和 不良临床结局（AIM 1）。我们还将通过系统发育分析来定义传播动力学 从症状性PWID（AIM 2）的SAR-CoV-2序列，并确定是否艾滋病毒护理和伤害 减少服务提供中断与对ART和美沙酮的依从性差有关， 病毒血症和其他不良后果（AIM 3）。我们的提案在如何传达给PWID和合作伙伴方面具有创新性 利用同伴教育者，在肯尼亚高危人群中进行有针对性的测试和症状筛查， 使用基因组学定义了COVID-19在本地网络内外的传播。参与者招募 登记将在肯尼亚内罗毕、蒙巴萨和基利菲的戒毒中心和美沙酮诊所进行 并且随访访视将每月进行一次，持续6个月。除了为SARS收集采访数据和血液外- CoV-2抗体，我们将在7次访视中的任何一次访视中询问具有与COVID-19一致的症状的参与者 自行采集鼻拭子样本进行SARS-CoV-2聚合酶链反应（PCR），然后进行基因组 如果是阳性，则进行测序。将在内罗毕进行抗体和病毒PCR检测的实验室分析， 阳性样本将被运送到西雅图进行测序和系统发育分析。我们预计， 研究结果将强调对艾滋病感染者进行有针对性的检测的必要性，并为艾滋病毒的干预和项目提供信息 在地球仪上为类似的边缘化群体提供戒毒护理和治疗 COVID-19和其他公共卫生危机。

ABSTRACT In sub-Saharan Africa and globally, many persons who inject drugs (PWID) are living with undiagnosed or untreated HIV, experience high levels of poverty, food and housing instability, and discrimination, and have increased risk for health conditions that contribute to worse outcomes from COVID-19. It is also more challenging for PWID to access healthcare when services have been limited by lockdowns and measures to ensure social distancing to prevent spread of respiratory viruses, such as SARS-CoV-2. We propose to recruit and follow a cohort of 500 HIV-positive and 500 HIV-negative PWID and their partners, many of whom also have hepatitis C, to determine whether poorly controlled HIV infection, active drug use and other HIV- and PWID-specific risk factors result in increased likelihood of COVID-19 acquisition, viral transmission, symptomatic disease and poor clinical outcomes (AIM 1). We will also define transmission dynamics through phylogenetic analyses of SAR-CoV-2 sequences from symptomatic PWID (AIM 2) and determine whether HIV care and harm reduction service delivery disruptions are associated with poor compliance to ART and methadone, HIV viremia and other adverse outcomes (AIM 3). Our proposal is innovative in how it reaches PWID and partners using peer educators, employs targeted testing and symptom screening in this high-risk Kenyan population, and defines COVID-19 transmission within and beyond local networks using phylogenetics. Participant recruitment and enrollment will take place in drop-in centers and methadone clinics in Nairobi, Mombasa and Kilifi, Kenya and follow-up visits will occur monthly for 6 months. In addition to collecting interview data and blood for SARS- CoV-2 antibodies, we will ask participants who have symptoms consistent with COVID-19 at any of the 7 visits to self-collect a nasal swab specimen for SARS-CoV-2 polymerase chain reaction (PCR), followed by genome sequencing if positive. Laboratory assays for antibody and viral PCR testing will be conducted in Nairobi and positive specimens will be shipped to Seattle for sequencing and phylogenetic analysis. We anticipate that our results will highlight the need for targeted testing among PWID and inform interventions and programs for HIV and addiction care and treatment across the globe for similar marginalized populations when confronted with COVID-19 and other public health crises.