Advancing Precision Public Health: an implementation science framework for HIV Cluster Detection and Response driven...

Area of Science:

• Epidemiology
• Genomics
• Implementation Science

Background:

• The UNAIDS 2026-2031 Global AIDS Strategy necessitates a shift from generalized to precision HIV prevention.
• Existing HIV surveillance methods require enhancement to integrate advanced genomic technologies.

Purpose of the Study:

• To develop an implementation science framework for Precision Public Health (PPH) in HIV Cluster Detection and Response (CDR).
• To integrate genomic surveillance advancements into public health pipelines for adaptive HIV transmission monitoring.

Main Methods:

• Synthesized advancements in UMI-NGS and Third-Generation Sequencing (TGS) for public health.
• Proposed adaptive, subtype-specific genetic distance thresholds and effective reproduction number (Re) for transmission volatility.
• Operationalized the PPH framework using Disease Intervention Specialists (DIS) with Data-to-Care models and Enhanced Social Network Strategies (eSNS).

Main Results:

• A predictive model simulating the CRF07_BC_N lineage in China projected a 60% reduction in cluster transmission rates with DIS-led interventions.
• Demonstrated the translation of high-resolution genomic data into actionable public health intelligence.
• Embedded an HIV Data Justice ethical structure to address risks associated with Molecular HIV Surveillance (MHS).

Conclusions:

• The proposed framework effectively bridges molecular biology and frontline epidemiology for targeted HIV interventions.
• Synchronizing high-resolution genomics with DIS-led field interventions and tiered resource allocation enhances HIV prevention strategies.
• This PPH approach supports the UNAIDS Global AIDS Strategy by enabling precise and ethical HIV response.