The changing face of HIV in the era of COVID-19: Maximising HIV incidence reduction through dynamic targeting of current and future distributions of acquisition risk.

项目摘要 南非是世界上艾滋病毒流行最多的国家，目前有780万人感染艾滋病毒。 艾滋病。过去十年来，艾滋病毒治疗和预防工作的扩大， 在2010年至2020年期间，近一半的新艾滋病毒感染和艾滋病相关死亡。 尽管取得了这一成功，但我们的团队提出的证据表明， 感染在时间和空间上以及在年龄-性别层次上并不均匀。这种不均匀 风险降低导致艾滋病毒风险格局发生变化， 弱势群体两大事件可能会导致风险格局的进一步变化。 第一个是转向以多鲁特韦为基础的抗逆转录病毒治疗方案。二是 2019冠状病毒病大流行造成的卫生服务中断， 艾滋病毒护理提供方面的挑战。 我们这项提案的长期目标是设计下一代艾滋病毒联合预防 撒哈拉以南非洲贫穷农村社区的战略，这将最大限度地提高艾滋病毒感染率 通过确定和针对最脆弱的亚群体来减少。我们设想 尽早确定新出现的脆弱亚群体将成为一个关键因素， 一个有效的方案反应。我们的项目将利用一个最大的正在进行的 世界上基于人口的艾滋病毒队列-非洲卫生研究所的人口 夸祖鲁-纳塔尔农村队列研究，包括个体水平的社会人口学、生物学和临床数据 以及全面的基因组数据在完全集成的个人数据平台。的 该项目将利用该研究所现有的基础设施和高分辨率数据来（i）量化 新的艾滋病毒感染在空间、时间和人口负担方面的变化（2022-2026年）; 以及（ii）了解艾滋病毒流行的动态变化，以设计未来的干预措施 根据大多数人的动态需求，最大限度地降低艾滋病毒发病率的方案 弱势群体。

Project Summary South Africa has the largest HIV epidemic worldwide with 7.8 million people currently living with HIV. The scaling up of HIV treatment and prevention over the past decade has led to a reduction of nearly half of new HIV infections and AIDS related deaths between 2010 and 2020. Notwithstanding this success, our team has presented evidence showing that reduction in new infections is not homogeneous over time and space and across the age-sex strata. This uneven risk reduction has led to a shift in the HIV risk landscape resulting in the emergence of new vulnerable groups. Two major events are likely to cause further changes to the risk landscape. The first is the shift to Dolutegravir-based antiretroviral treatment regimens. The second is the disruptions of health services caused by the COVID-19 pandemic creating unprecedented challenges in HIV care delivery. Our long-term goal for this proposal is to design the next-generation HIV combination prevention strategies for poor rural communities in sub-Saharan Africa, which will maximize HIV incidence reduction through identification and targeting of the most vulnerable sub-groups. We envisage that early identification of emergent vulnerable subpopulations would become a key element for an effective programmatic response. Our project will take advantage of one of the largest ongoing population-based HIV cohorts in the world – the Africa Health Research Institute’s population cohort in rural KwaZulu-Natal, with individual-level sociodemographic, biological, and clinical data as well as comprehensive genomics data in the fully integrated individual data platform. The project will leverage the institute’s existing infrastructure and high-resolution data to (i) Quantify the shifts in the spatial, temporal and demographic burden of new HIV infections (2022-2026); and (ii) Harness the changes in the dynamics of the HIV epidemic to design future intervention programs which will maximize HIV incidence reduction based on the dynamic needs of the most vulnerable sub-populations.