Saturday, June 7, 2025
6/7/2025
Real Time Phylogeny and Contact Tracing to Disrupt HIV Transmission - Real Time Phylogeny and Contact Tracing to Disrupt HIV Transmission Kantor, Rami MD SUMMARY HIV transmission remains a global challenge, and innovative approaches within constrained public health systems are needed for its disruption. Though actual transmission networks are unknown, characterizing social and phylogenetic networks can guide public health interventions towards preventing HIV transmission. Contact tracing is the current public health tool to derive and characterize social networks and identify, notify, test and link to care partners of those newly diagnosed. Analysis of molecular HIV clusters by genetic distance-based methods is now recommended in the US to detect outbreaks as part of ending the HIV epidemic. However, the added value of phylogenetic (beyond distance-based) cluster analyses and how they may focus and benefit routine (beyond outbreaks) public health activities to reduce transmission is an existing knowledge gap. In the prior cycle we started to address this gap, established a strong academic-governmental Partnership in Rhode Island, developed a bioinformatics pipeline to share and analyze statewide data, and for the first-time routinely and in near-real-time conducted cluster analyses, identified recent HIV diagnoses who were part of molecular clusters, and attempted to re-interview all of them, to increase their motivation and enhance contact tracing. The important finding that despite better cluster detection a re-interview was not beneficial, together with our achievements in the prior cycle, informed and refocused this Renewal, guiding its restructured scope. In this Renewal, leveraging the Partnership we established and our gained experience, we propose to redesign our bioinformatics pipeline to routinely and in near-real-time conduct cluster analyses and integrate molecular data with typically siloed clinical and public health data, use them to prioritize all individuals and clusters with new sequences, use this prioritization to inform tailored and intensive public health interventions, and evaluate the impact of these processes, while improving representation and phylogenetic inference of the local and regional epidemic. We hypothesize that these innovative approaches will focus restricted public health efforts and more efficiently identify and link to care persons unaware of their HIV status, persons aware but not linked to care, or persons at high risk of getting infected. The Specific Aims to address this hypothesis are to: (1) Redesign the pipeline and conduct near-real-time cluster analyses in and beyond Rhode Island; (2) Leverage the redesigned pipeline to evaluate the added value of routine, near-real-time integration of cluster analyses prioritizing public health interventions; and (3) Augment phylogenetic inference by increased sequence availability and more comprehensive analyses. Our approach is strengthened by a multidisciplinary experienced team of public health officials, ethicists, clinicians, statisticians, bioinformaticians, behavioral scientists, evolutionary and molecular biologists, with infrastructure and expertise developed in the prior cycle. This Renewal, built on a strong Ethics Platform, will have high impact on the care continuum; bring Rhode Island closer to zero new HIV infections; and serve as a model for larger jurisdictions, as we aim to end the HIV epidemic in Rhode Island and beyond.
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