PROJECT SUMMARY/ABSTRACT Antimicrobial resistance (AMR) is a global health emergency. Neisseria gonorrhoeae is a high-priority pathogen for AMR, as there are 87 million infections per year worldwide and the bacteria has demonstrated resistance to every class of antibiotics recommended for its treatment. Treatment failures have been reported, typically involve oropharyngeal infections, and are dire warnings that the era of untreatable gonorrhea is near. In the Western Pacific Region, which includes Vietnam, resistance to ceftriaxone and azithromycin, the most commonly recommended antibiotic therapy for gonorrhea, are increasing. Men who have sex with men (MSM) are disproportionately affected by AMR in N. gonorrhoeae infections, but remain under-represented in data from low- and middle-income countries (LMICs). The proposed study seeks to better understand AMR in N. gonorrhoeae by embedding new research into an existing HIV pre-exposure prophylaxis (PrEP) program for MSM in Vietnam. The study aims are 1) to determine the prevalence of and risk factors for AMR in N. gonorrhoeae among MSM in a PrEP program in Vietnam; 2) to measure the frequency of pharyngeal N. gonorrhoeae treatment failures and the association between pharyngeal infections and AMR; and 3) to use whole-genome sequencing (WGS) to conduct a genomic epidemiology study of N. gonorrhoeae nested within our study population of MSM in a PrEP program in Vietnam. The study will leverage regular testing for N. gonorrhoeae and follow-up that occur through the PrEP program to shed new light on the issue of AMR in N. gonorrhoeae within this key population. This Fogarty International Research Scientist Development Award (K01) is to support the career development of Dr. Paul Adamson, an infectious diseases physician whose goal is to become an independent global health investigator at the intersection of AMR and sexually transmitted infections (STIs). The K01 will support Dr. Adamson to develop expertise in 1) clinical microbiology and AMR testing, 2) WGS, bioinformatics, and genomic epidemiology, and 3) advanced training in clinical trials research with a focus in LMICs. To achieve the proposed research and training aims, Dr. Adamson has assembled a mentorship team with proven experience mentoring early-career investigators and with expertise in STIs, epidemiology, AMR, biostatistics, and genomics. Drs. Pamina Gorbach (UCLA) and Le Minh Giang (Hanoi Medical University, HMU) will serve as Primary Mentors and have extensive experience in conducting large-scale prevention research studies and clinical trials on STIs and HIV among MSM. In addition, his Co-Mentorship team includes Dr. Jeffrey Klausner, a US-based global health researcher and an international expert on STIs and AMR in N. gonorrhoeae, and Dr. Nguyen Vu Trung, a Vietnam-based researcher with expertise in clinical microbiology and antibiotic susceptibility testing in N. gonorrhoeae. The proposed research and training aims leverage the strong research collaborations and the robust research infrastructure that exist between UCLA and HMU. The IRSDA will advance Dr. Adamson's career as an expert in STIs and AMR and establish him as an independent global health investigator.

PROJECT NARRATIVE Antimicrobial resistance (AMR) in Neisseria gonorrhoeae is an urgent global health threat and the prevalence is highest in the Western Pacific Region. The proposed study will identify risk factors for AMR, measure treatment outcomes of pharyngeal infections, and investigate the genomic epidemiology of AMR in N. gonorrhoeae among men who have sex with men in an HIV pre-exposure prophylaxis (PrEP) program in Vietnam. By contributing new knowledge about AMR in N. gonorrhoeae and providing crucial information from a population at high risk for AMR, this proposal will help guide public health efforts aimed at mitigating the spread of drug-resistant gonorrhea.