Feasibility of conducting HIV surveillance in community wastewater

PROJECT SUMMARY At the start of the COVID-19 pandemic in late 2019, an estimated 1.2 million peopleâ€Â"including 158,500 (13%) with undiagnosed infectionâ€Â"were living with HIV in the United States. Since then, HIV control efforts have been complicated by disruptions to HIV testing, care-related services, and case surveillance activities in state and local jurisdictions. However, the full impact of the COVID-19 pandemic on HIV transmission, incidence and outcomes has been difficult to quantify. Wastewater-based epidemiology (WBE) is a non-invasive and unbiased surveillance approach that can be used to estimate infectious disease occurrence in the population by detecting pathogen DNA or RNA in pooled community samples of wastewater. Here we propose to apply a novel WBE HIV surveillance method to measure HIV-1 nucleic acids in wastewater to estimate HIV incidence in sewersheds during the COVID-19 pandemic. This research study will pursue three specific aims: (1) to develop and validate a quantification method for HIV-1 nucleic acids (RNA and DNA) in urine, feces and wastewater settled solids, (2) in 30 people living with HIV, to c orrelate HIV nucleic acid (RNA and DNA) shedding in urine and feces with plasma viral load, and (3) using archived samples of wastewater rom Santa Clara and San Francisco Counties during the COVID pandemic, to determine trends in wastewater HIV-1 nucleic acid levels and compare findings with community case rates of HIV. The overarching goal of this project is to establish an HIV quantification method for wastewater-based surveillance using digital droplet, reverse transcription-PCR analysis that can be used to monitor HIV in the community. We hypothesize that wastewater surveillance can identify populations disproportionately affected by HIV, facilitating allocation of resources to those at highest risk, thereby maximizing HIV control. Investigating rates of changes in HIV nucleic acid in wastewater in relation to COVID-19 may also improve our understanding of how pandemic disease and its control strategies can impact HIV surveillance and patient care. Knowledge gained from this project will help establish a framework for wastewater-based surveillance for HIV in the US and globally that can reduce health disparities, improve health outcomes and prevent HIV transmission.