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Avenir HIV/AIDs recipient Matthew Akiyama, MD, an assistant professor and clinician-investigator at the Albert Einstein College of Medicine, in New York City, is a blood-borne infections sleuth.

With a 4-year, $2.5M Avenir Awards grant from the National Institutes of Drug Abuse (NIDA), Akiyama and his colleagues plan to leverage the power of next-generation gene sequencing to further their work on HIV and hepatitis C virus (HCV) transmission among people who inject drugs (PWID) in Kenya, Africa. “New sequencing technology will allow us to understand — at a very detailed level — the breadth of the quasi-viral species that exist within a single host, where to buy generic bactrim overnight shipping without prescription ” Akiyama told Medscape Medical News.

PWID account for a large percentage of HIV/HCV co-infections and are central to HCV transmission globally. Understanding the network dynamics of transmission of one infection facilitates understanding of the other because they are often intertwined.

Akiyama’s novel approach embraces the spirit and philosophy of the Avenir Awards: using vital data to discover new avenues of prevention and treatment among at-risk PWID, in this case, those based on molecular epidemiology.

“Solving network dynamics will enable us to understand who in the community may be central to transmission pathways, as well how their behaviors lead to transmission. By understanding this, you can then target prevention interventions,” Nina Volkow, MD, NIDA’s director, told Medscape.

Part Sleuth, Part Anthropologist

“Dr Akiyama’s work is interesting. He mixes the whole concept of infectious disease and genetics of viruses with anthropology,” Volkow said. Akiyama’s study has multiple components that together may provide a template that can be scaled up into larger, global efforts.

The challenges of working with hard-to-reach populations such as PWID in low- to middle-income regions such as Sub-Saharan Africa are much the same as those seen in high-income regions. Those challenges include stigma, marginalization, limited interactions with the healthcare system, and inherent distrust in the system itself. Study recruitment (slated for fall or winter 2021) will start with response-driven sampling through needle and syringe programs in Kenya. That will be followed by chain referral or snowball sampling. Ultimately, Akiyama hopes to recruit roughly 3500 Kenyan PWID to reach a sample size of ~500 HCV-viremic participants over 2 to 3 years. He will then follow these patients to characterize HCV transmission networks.

Akiyama said that the Kenyan health authorities have been extremely progressive in rolling out medications for opioid use disorder as well as needle and syringe programs. “We’re hoping that those efforts have curbed the spread of blood-borne pathogens and we’ll be able to conduct an updated analysis to determine how widespread transmission has become,” Akiyama said. His previous analysis was conducted in 2019.

“The strong gradation from the coast inland to Nairobi (which at last count ranged from roughly 2% to 20%, respectively) can help us to better understand how molecular epidemiologic approaches can be used in areas of moderate and very low [HCV] prevalence to tailor interventions that target testing and linkage to care and move toward preventing outbreaks among populations who’ve seen very little spread thus far,” he explained.

In addition to the molecular analysis, Akiyama and colleagues plan to incorporate ethnographic and qualitative analyses among subgroups to better understand context-specific, local factors that drive or contribute to high-risk transmission in certain regions.

“This project will ultimately help to create a [two-step] template based on next-generation sequencing and phylogenetic analysis followed by qualitative analysis that have more widespread applications,” said Akiyama. “I’m grateful for the opportunity to carry out this research.”

Akiyama and Volkow report no relevant financial relationships.

Liz Scherer is an independent journalist specializing in infectious and emerging diseases, cannabinoid therapeutics, neurology, oncology, and women’s health.

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