Understanding the Epidemiology of Syphilis in the United States

项目摘要/摘要 梅毒在美国正在增加(美国)巴尔的摩有一种最严重的流行病 黑人同性恋者、双性恋者和与男性发生性关系的男性(MSM)。种族差异和新梅毒的数量 感染和再感染表明，我们目前的预防战略并不有效。建议数 这项研究将对梅毒的流行病学和传播动力学有新的了解。 黑人男男性接触者，包括感染艾滋病毒和未感染的美国城市地区男男性接触者，以确定方法 改变和加强当地卫生部门的做法。我们将明确解决当前实践中的限制 以及以前对梅毒预防-护理连续体的关键方面的研究，包括：梅毒病例 发现、获得和完成治疗、治疗随访以及再感染和合并感染的可能性。 随着时间的推移感染艾滋病毒和其他性传播疾病。我们的方法将包括对黑人MSM的队列研究， 受访者主导的抽样，重点放在性网络形成的地方，如性伴侣 会场(如俱乐部、酒吧、互联网网站、公园)及其背景，因为场馆已被证明是一种 接触梅毒高危人群的有效方法。 我们的具体目标是：(1)确定性伴侣会议的地点及其特点(如类型、地点 网络中心性)以及社会和性网络个人危险行为(例如，不戴避孕套的性行为， 新伴侣、药物使用)与新梅毒发病率和随时间推移的重复梅毒有关；(2) 确定个人(例如，医疗服务的获取和使用模式、保险状态、到诊所的距离、 物质使用)、社会网络(例如，支持、风险网络)和系统层面(例如，医疗保健的可用性 服务、文化能力因素。感觉到的耻辱)与治疗相关的医疗保健相关因素 随时间推移完成和参与梅毒的随访；以及(3)检查临床因素的影响 (例如梅毒分期、再感染、基线非梅毒螺旋体滴度、艾滋病毒和PrEP状态)对非梅毒螺旋体的变化 治疗后随着时间的推移，梅毒螺旋体抗体滴度增加。 我们的研究将由巴尔的摩市卫生局(BCHD)合作设计和进行， 约翰霍普金斯大学(JHU)和疾病控制与预防中心(CDC)通报针对梅毒的公共卫生目标控制活动 病态梅毒/艾滋病毒感染。BCHD和JHU在以下领域有着长期、成功的伙伴关系 将证据转化为公共卫生实践。此外，我们的专家团队拥有丰富的经验和 在纵向研究中显示了过去在招募和留住MSM方面的表现，并在 收集社会人口学、流行病学、性和社会网络数据和生物标本 研究目的。此外，我们还带来了丰富的梅毒临床护理和研究、性伴侣的记录 会场研究并将证据转化为公共卫生实践。

Project Summary/Abstract Syphilis is increasing in the United States (U.S.) and Baltimore has one of the most severe epidemics among Black gay, bisexual and men who have sex with men (MSM). The racial disparities and number of new syphilis infections and reinfections demonstrate that our current prevention strategies are not effective. The proposed study will provide a new understanding of the epidemiology and transmission dynamics of syphilis among Black MSM including HIV infected and uninfected MSM for urban areas in the U.S. in order to identify ways to alter and strengthen local health department practices. We will explicitly address limitations in current practice and previous research on key aspects of the syphilis prevention-care continuum including: syphilis case finding, access to and treatment completion, treatment follow-up and the likelihood of reinfection and co- infection with HIV and other STIs over time. Our approach will include a cohort study of Black MSM, respondent driven-sampling and a focus on places where sexual networks are formed such as sex partner meeting venues (e.g. clubs, bars, internet sites, parks) and their context, as venues have been shown to be an effective method of accessing hard-to-reach populations at risk for syphilis. Our Specific Aims are to: (1) Determine sex partner meeting venues and their characteristics (e.g. type, venue network centrality) as well as social and sexual network individual risk behaviors (e.g. sex without a condom, new partners, substance use) associated with new syphilis incidence and repeat syphilis over time; (2) Determine individual (e.g. health care access and usage patterns, insurance status, distance to clinic, substance use), social network (e.g. support, risk network) and systems level (e.g. availability of health care services, cultural competency factors. perceived stigma) healthcare-related factors associated with treatment completion and engagement in follow-up for syphilis over time; and (3) Examine the impact of clinical factors (e.g. syphilis stage, reinfection, baseline nontreponemal titers, HIV and PrEP status) on changes in non- treponemal antibody titers over time following treatment. Our study will be cooperatively designed and conducted by the Baltimore City Health Department (BCHD), Johns Hopkins University (JHU) and CDC to inform public health targeted control activities for syphilis and co- morbid syphilis/HIV infection. The BCHD and JHU have a long-standing, successful partnership in the translation of evidence to public health practice. In addition, our expert team has extensive experience and demonstrated past performance in recruitment and retention of MSM in longitudinal studies, and in the collection of sociodemographic, epidemiologic, sexual and social network data and biologic specimens for research purposes. In addition, we bring a rich track record of syphilis clinical care and research, sex partner meeting place research and translation of evidence to public health practice.