Leveraging HCV Phylogenetic Networks to Prevent HIV and Other Blood Borne Infections Among People Who Inject Drugs

ABSTRACT HIV remains a significant cause of morbidity and mortality among people who inject drugs (PWID). Between 2011 and 2017, new HIV infections among adults worldwide declined by 14%; however, there has been no decrease in the annual number of new HIV infections among PWID. In fact, the incidence appears to be rising. PWID also bear a disproportionately high burden of other blood borne infections including HCV and HBV. In an update to the 90-90-90 HIV treatment targets, the HIV epidemic by 2030. Similarly, WHO has threat by 2030. To achieve UNAIDS and WHO?s targets, innovative strategies will be required among marginalized populations such as PWID, especially in low- and middle-income countries (LMICs) where coverage of UNAIDS issued a declaration of commitment to e nd called for elimination of viral hepatitis as a major public health needle and syringe programs and medication-assisted therapy may be limited. The overarching goal of this proposal is to inform a targeted public health strategy to prevent transmission of HIV and other blood borne infections among PWID. To accomplish this, we will leverage the high transmissibility and genetic diversity of HCV to identify PWID who are of high centrality in transmission networks in Kenya, East Africa. We will then determine demographic, behavioral, virologic, and geographic risk factors and model the impact of public health interventions targeted toward high centrality PWID on transmission of HIV and other blood borne infections. The strategy we propose aims to meet a critical need by supplying new molecular epidemiologic tools to inform development and revision of national and international strategies that can maximize the impact of prevention efforts for HIV and other blood borne infections. We expect this study to provide essential information for policy makers and researchers seeking to identify key priorities and strategies for blood borne infection prevention in settings where HIV and viral hepatitis epidemics are converging among PWID. In addition to providing evidence with immediate relevance to policy, the approach developed in this study will provide a durable template for further analyses, including prospective assessment of other targeted HIV prevention and HCV elimination strategies among PWID; and monitoring of progress towards key goals for reducing the burden of HIV, HCV, and other blood borne infections among PWID in resource limited settings.