Real Time Phylogeny and Contact Tracing to Disrupt HIV Transmission Kantor, Rami MD
SUMMARY
Prevention of HIV transmission is still a major global challenge, and innovative methods are needed for its
disruption. Though actual transmission networks are unknown, characterizing social and phylogenetic
networks can guide prevention interventions. Contact tracing is the current public health tool to derive social
networks and identify, notify, test and link to care partners of newly-diagnosed HIV cases. Phylogenetic
analysis of available sequences is used in research to characterize epidemics and has facilitated outbreak
investigations. However, real time integration of phylogenetics with contact tracing on a public health, state-
wide level has not been evaluated. We propose to prospectively integrate phylogenetic analysis with contact
tracing in real time, and evaluate the impact of such integration on HIV infection in Rhode Island (RI). We
hypothesize that real time use of information from phylogenetic inference can enhance contact tracing,
improve HIV testing, diagnoses and linkage to care, and disrupt transmission. The Specific Aims are to: (1)
Conduct real time phylogenetic analyses of patient-level sequence data; (2) Augment phylogenetic inference
by increased sampling and more comprehensive testing; and (3) Evaluate the benefit of real time integration of
phylogenetics with contact tracing efforts. We will develop and automate tools to incorporate phylogenetic and
phylodynamic inference into contact tracing, explore its enhancement, and evaluate its real time impact, with
special consideration of key populations like men who have sex with men, intravenous drug users and persons
with HIV drug resistance. We expect that this approach will improve identification and linkage to care of
infected-unaware individuals, infected-aware individuals not linked to care, and uninfected individuals that are
at high risk of infection. The main premise of this proposal is that phylogenetic networks contain
information which can expand social networks and impact HIV transmission. If our hypothesis is correct,
this research will have high impact on HIV prevention and the care continuum and disrupt HIV transmission in
Rhode Island. The rigor of our research approach is strengthened by our multidisciplinary team of clinicians,
public health officials, statisticians, bioinformaticians, evolutionary and molecular biologists, combined with our
relevant existing data and expertise, the small size of the state and the strong and close academic-public
health partnership. Furthermore, important and essential ethics considerations are directly addressed and
incorporated throughout. Such an approach will make results generalizable and sustainable, allowing focused
resource allocation and continuous implementation and generalization of findings. In 2013 the Director of the
RI Department of Health declared the vision of ‘Getting to Zero’ new HIV infections in the state within the next
five years, however apparent increases in transmission among high risk networks has impeded progress. This
proposal will help bring small RI closer to its goal of being the first state to get to zero new infections and
demonstrate how focusing efforts can prevent HIV transmission in RI and beyond.