Spatial and molecular epidemiology of hepatitis B transmission in the Democratic Republic of the Congo

项目摘要 尽管有有效的疫苗，但B型肝炎病毒（HBV）仍然在撒哈拉以南非洲（SSA）流行。而 围产期母婴传播一直是HBV持续流行的流行理论， 在亚洲的研究中，来自撒南非洲的有限证据表明， 是SSA背景下传播的一个更重要的驱动因素。鉴于乙肝疫苗接种的规模扩大将是缓慢的， 不足以达到世界卫生组织到2030年消除HBV的目标， 需要采取措施控制HBV，这首先需要更好地了解HBV在SSA中的传播。 刚果民主共和国（DRC）的全国HBV患病率约为3.3%， 在高级肝病护理基本上是 难以接近该提案建立在科学家之间强大的研究基础设施（约20年）上， 位于查佩尔山的北卡罗来纳州大学和刚果民主共和国首都金沙萨，研究HBV 传播使用的数据和样本来自一个正在进行的家庭为基础的病例对照研究， 刚果民主共和国最新的全国人口和健康调查。该提案的总体目标是改善 了解HBV在资源匮乏的撒哈拉以南非洲地区的传播情况。 该提案的具体目标是：1）描述HBV传播的流行病学特征， 刚果民主共和国金沙萨市的家庭，并确定相关的个人、家庭和社区 风险因素; 2）调查社区水平传播的证据， 系统发育分析 通过本研究建议和精心制定的培训计划，受训者将实现以下目标 研究金目标：1）发展独特的跨学科研究技能，将流行病学， 地理，遗传学和传染病; 2）从事有意义的临床培训，将提高 学员未来的临床实践和研究成果转化为临床相关的干预措施;以及 3)发展专业技能，以促进作为一名物理学家-科学家的成功学术生涯。

Project Abstract Hepatitis B virus (HBV) remains endemic in sub-Saharan Africa (SSA), despite an effective vaccine. While perinatal transmission from mother-to-child has been the prevailing theory for continued HBV endemicity based on studies in Asia, limited evidence from SSA suggests transmission at the household- and community-levels is a more important driver of transmission in SSA contexts. Given that scale-up of HBV vaccination will be slow and insufficient to reach the World Health Organization goal of HBV elimination by 2030, additional prevention measures are needed for HBV control, which first require a better understanding of HBV transmission in SSA. The Democratic Republic of the Congo (DRC) has a national HBV prevalence of ~3.3%, which translates to approximately 3.5 million chronic infections in a setting where advanced hepatology care is essentially inaccessible. This proposal builds upon a strong research infrastructure (~20 years) between scientists at the University of North Carolina at Chapel Hill (UNC) and in DRC’s capital city, Kinshasa, to study HBV transmission using data and samples from an ongoing household-based case-control study and from the DRC’s latest national Demographic and Health Survey. The overall goal of this proposal is to improve understanding of HBV transmission in a low-resourced, sub-Saharan Africa setting. The specific aims of this proposal are: 1) Characterize the epidemiology of HBV transmission in households in urban Kinshasa, DRC, and identify associated individual, household, and community risk factors; and 2) Investigate evidence of community-level horizontal transmission using phylogenetic analysis. Through this research proposal and a carefully constructed training plan, the trainee will achieve the following fellowship goals: 1) develop a unique and interdisciplinary research skillset that integrates epidemiology, geography, genetics, and infectious diseases; 2) engage in meaningful clinical training that will enhance the trainee’s future clinical practice and the translation of research findings to clinically relevant interventions; and 3) develop professional skills that will facilitate a successful academic career as a physician-scientist.