Integrating Assisted Partner Services and Phylogenetics for HIV and HCV Prevention

摘要 为了遏制肯尼亚和撒哈拉以南非洲其他地区的艾滋病毒流行，创新战略以确定 治疗注射毒品的艾滋病毒感染者(PWID)至关重要。同样重要的是，因素 如果要制定预防和治疗方案，就更好地了解对继续传播的贡献 针对主要受影响人群进行规模化。这项研究将由凯里·法夸尔博士和约书亚博士共同领导 Herbeck是华盛顿大学肯雅塔国家医院、 夸祖鲁-纳塔尔大学，肯尼亚卫生部和当地一个非政府组织，支持预防和吸毒 在非洲的治疗(SAPTA)。这项研究将确定是否帮助感染艾滋病毒的PWID通知他们的 合作伙伴可以成功实施艾滋病毒检测战略，并与关怀联动，以及是否协助合作伙伴 通知服务(APS)可用于识别丙型肝炎(丙型肝炎)高危人群。初级阶段 目的是确定每个感染HIV的PWID中有多少人共用针头和性伴侣接触HIV 检测服务可以被检测、诊断为艾滋病毒或丙型肝炎阳性，与适当的服务相联系，并参与 在测试后3个月进行护理。为了实现这一目标，在APS方面经验丰富的健康顾问将招募和招募1000名 在内罗毕Mathare贫民窟的3个针头注射器项目诊所，感染艾滋病毒的参与者。与.一起 来自萨普塔的同伴教育人员，研究健康顾问将告知合作伙伴艾滋病毒和丙型肝炎病毒的暴露情况，并 安排在诊所或其他地点进行测试。这一策略尚未用于艾滋病或丙型肝炎的PWID， 然而，最近证明它在肯尼亚的普通民众中是可以接受和可行的。我们的 第二和第三个目标是利用APS的能力来识别新的艾滋病毒和丙型肝炎病例，并使用系统发育学来 描述在这一关键人群中传播艾滋病毒和丙型肝炎病毒的传播方式和风险因素。 将在滤纸上收集网络中1000名艾滋病毒感染者和1000名丙型肝炎病毒感染者的血点 夸祖鲁-纳塔尔大学的研究实验室将对艾滋病毒和丙型肝炎病毒进行测序。这种类型的 分子流行病学方法还没有在这一人群中用于艾滋病毒或丙型肝炎病毒，并有很大的希望 当与社会人口和行为数据的收集相结合以确定人口水平因素时 对这两种病毒的进一步传播起到了重要作用。我们预计，我们的结果将塑造 肯尼亚和撒哈拉以南非洲未来预防工作的成功，使公共卫生方案能够 以高风险集群为目标，这将反过来为更深入地研究有效筛查和 服务交付PWID。

ABSTRACT To contain the HIV epidemic in Kenya and other parts of sub-Saharan Africa, innovative strategies for identifying and treating HIV-infected persons who inject drugs (PWID) are critically important. It is also essential that factors contributing to onward transmission are better understood if prevention and treatment programs are to be brought to scale for key affected populations. The study will be co-led by Dr. Carey Farquhar and Dr. Joshua Herbeck and is a collaborative effort between the University of Washington, Kenyatta National Hospital, the University of Kwa-Zulu-Natal, Kenya Ministry of Health and a local NGO, Support for Addiction Prevention and Treatment in Africa (SAPTA). The study will determine whether assisting HIV-infected PWID to notify their partners can be a successful strategy for HIV testing and linkage to care, and whether assisted partner notification services (APS) can be leveraged to identify individuals at high risk for hepatitis C (HCV). The primary objective is to determine how many needle-sharing and sexual partners per HIV-infected PWID accessing HIV testing services can be tested, diagnosed HIV- or HCV-positive, linked to appropriate services, and engaged in care at 3 months post-testing. To achieve this, health advisors experienced in APS will recruit and enroll 1000 HIV-infected participants at 3 needle-syringe program clinics in the Mathare slum area of Nairobi. Together with peer educators from SAPTA, study health advisors will inform partners of the exposure to HIV and HCV and arrange for testing at the clinic or another venue. This strategy has not been used among PWID for HIV or HCV, however, it has recently been shown to be acceptable and feasible in the general population in Kenya. Our second and third aims leverage the ability of APS to identify new HIV and HCV cases and use phylogenetics to characterize modes of transmission and risk factors for ongoing HIV and HCV transmission in this key population. Blood spots will be collected on filter paper from 1000 HIV-infected and 1000 HCV-infected PWID in the network and HIV and HCV will be sequenced at the University of KwaZulu-Natal research laboratory. This type of molecular epidemiology approach has not been used in this population for HIV or HCV and holds great promise when combined with collection of sociodemographic and behavioral data for defining population level factors contributing significantly to onward transmission of these two viruses. We anticipate that our results will shape the success of future prevention efforts in Kenya and sub-Saharan Africa by enabling public health programs to target high-risk clusters, and this will in turn pave the way for more in-depth research on effective screening and service delivery PWID.