Impact of a novel screening program to detect acute and prevalent HIV infection and reduce HIV transmission

新型筛查计划对检测急性和流行的艾滋病毒感染并减少艾滋病毒传播的影响

基本信息

批准号：
9336791
负责人：
Susan Marie Graham
金额：
$ 57.26万
依托单位：
UNIVERSITY OF WASHINGTON
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-08-24 至 2020-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9336791
关键词：
AIDS prevention Acute Address Adult Africa South of the Sahara African Algorithms Anti-Retroviral Agents Antigens Caring Cessation of life Clinical Consensus Cost Effectiveness Analysis Counseling Country Coupled Data Detection Development Diagnosis Diagnostic tests Disease Outbreaks Early Diagnosis Epidemic Evaluation Fever Foundations HIV HIV Infections HIV diagnosis HIV-1 Health Health Benefit Health care facility Healthcare Systems High Prevalence Human immunodeficiency virus test Individual Infection Interdisciplinary Study Intervention Kenya Lead Link Malaise Malaria Medical Medical Research Modeling Newly Diagnosed Notification Outcome Partner Notification Patients Persons Policies Prevention Prevention program Prevention strategy Preventive Intervention Privatization Provider Public Health RNA Research Research Institute Research Project Grants Resources Risk Risk Behaviors Risk Reduction Services Symptoms Syndrome Testing Universities Viral Load result Washington Work antiretroviral therapy base care seeking case finding clinical care cost cost effective cost effectiveness design disability-adjusted life years editorial efficacy testing experience high risk behavior improved indexing innovation interdisciplinary approach novel point of care pre-exposure prophylaxis programs public health emergency screening seropositive service intervention standard of care transmission process uptake virology young adult

项目摘要

Project Summary Detection and management of acute HIV infection (AHI) is a clinical and public health emergency, and HIV infections diagnosed among young adults are usually recent. Young adults with recent HIV acquisition frequently seek care for symptoms, and could potentially be diagnosed through the health care system. Although over 50% of persons living with HIV infection in Kenya are unaware of their status, facility-based HIV testing is underutilized and available tests cannot diagnose AHI. Early recognition of HIV infection provides considerable individual and public health benefits, including reduction in risk behavior, notification of partners in need of HIV testing, access to counseling and treatment, and viral load suppression, if achieved. In this R01 application, we propose a multidisciplinary research project that builds on pilot work carried out in coastal Kenya to detect AHI among young adults seeking care for symptoms compatible with acute retroviral syndrome. Our highly productive research team, including collaborators from the University of Washington, University of Oxford, and Kenya Medical Research Institute, has expertise in the fields of clinical care (Dr. Graham), HIV prevention (Dr. Sanders), partner counseling and notification services (Dr. Farquhar), risk behavior and network evaluations (Dr. Goodreau), and costing of interventions (Dr. Babigumira). Our specific aims are to: (1) identify and test 1,500 adults identified by our AHI screening algorithm for acute and prevalent (i.e., seropositive) HIV, linking all newly diagnosed HIV-infected patients to care and offering immediate treatment; (2) offer assisted partner notification services (aPS) to all cases detected, screening partners for acute and prevalent HIV infection and identifying local sexual networks; and (3) model the potential impact of these two interventions on the Kenyan HIV epidemic, estimating incremental costs per HIV infection averted, death averted, and disability-adjusted life-year averted using data on outcomes from our innovative program. We will use a modified stepped wedge design to evaluate the yield of this screening intervention at 2 public and 4 private health facilities in coastal Kenya, before and after intervention delivery. Our innovative intervention will use standard HIV rapid tests to diagnose prevalent HIV infection and point-of-care HIV-1 RNA testing to diagnose AHI among young adults presenting for care; use aPS to identify linked acute and prevalent infections; and follow all newly diagnosed patients and their partners for 12 months to ascertain clinical outcomes including linkage to care, ART initiation and virologic suppression in HIV-infected patients, and PrEP uptake in uninfected individuals in discordant partnerships. Building on our pilot work on AHI screening (Clinicaltrials.gov, NCT01876199) and our ground-breaking work on aPS in Kenya (Clinicaltrials.gov, NCT01616420), as well as our expertise in modeling and cost-effectiveness analysis, we will provide foundational data on the potential of this novel, combination HIV prevention intervention to significantly reduce ongoing HIV transmission in Kenya and other high-prevalence African settings.

项目概要急性艾滋病毒感染 (AHI) 的检测和管理是临床和公共卫生紧急事件，艾滋病毒年轻人中诊断出的感染通常是最近发生的。最近感染艾滋病毒的年轻人经常就症状寻求护理，并有可能通过医疗保健系统进行诊断。尽管肯尼亚超过 50% 的艾滋病毒感染者不知道自己的状况，但基于设施的艾滋病毒感染者检测未得到充分利用，可用的检测无法诊断 AHI。及早识别 HIV 感染可提供相当大的个人和公共健康益处，包括减少危险行为、通知合作伙伴如果实现的话，需要进行艾滋病毒检测、获得咨询和治疗以及抑制病毒载量。在这个R01 应用程序中，我们提出了一个多学科研究项目，该项目以沿海地区开展的试点工作为基础肯尼亚将在寻求与急性逆转录病毒相关症状的年轻人中检测 AHI 综合症。我们高效的研究团队，包括来自华盛顿大学的合作者，牛津大学和肯尼亚医学研究所在临床护理领域拥有专业知识（Dr. 格雷厄姆）、艾滋病毒预防（桑德斯博士）、伴侣咨询和通知服务（法夸尔博士）、风险行为和网络评估（Goodreau 博士），以及干预措施的成本计算（Babigumira 博士）。我们的具体目标是：(1) 通过我们的 AHI 筛查算法识别并测试 1,500 名成年人的急性和流行病（即血清反应呈阳性）艾滋病毒，将所有新诊断的艾滋病毒感染者与护理联系起来，并立即提供治疗治疗; (2) 为所有发现的病例提供辅助合作伙伴通知服务 (aPS)，筛选合作伙伴急性和流行的艾滋病毒感染并确定当地的性网络； (3) 对潜在影响进行建模这两项针对肯尼亚艾滋病毒流行的干预措施，估计了每次避免艾滋病毒感染所增加的成本，使用我们创新计划的结果数据避免了死亡，并避免了残疾调整生命年。我们将使用改进的阶梯式楔形设计来评估 2 个公共场所的筛查干预效果肯尼亚沿海的 4 个私人医疗机构在干预实施前后的情况。我们的创新干预措施将使用标准 HIV 快速检测来诊断流行的 HIV 感染和护理点 HIV-1 RNA 对就诊的年轻人进行 AHI 诊断测试；使用 aPS 来识别相关的急性和流行病感染；并对所有新诊断的患者及其伴侣进行为期 12 个月的随访，以确定临床情况结果包括与护理的联系、HIV 感染者的 ART 启动和病毒学抑制以及 PrEP 在不和谐的伙伴关系中未感染者的吸收。以我们的 AHI 筛查试点工作为基础（ClinicalTrials.gov，NCT01876199）以及我们在肯尼亚的 aPS 方面的开创性工作（ClinicalTrials.gov， NCT01616420），以及我们在建模和成本效益分析方面的专业知识，我们将提供关于这种新颖的艾滋病毒综合预防干预措施显着减少艾滋病毒感染的潜力的基础数据肯尼亚和其他非洲高流行地区持续存在艾滋病毒传播。