Structural Intervention to Increase Screening and Testing for Acute HIV Infection

加强急性艾滋病毒感染筛查和检测的结构性干预

• 批准号: 8136431
• 负责人: ROBERT H REMIEN
• 金额: $ 52.1万
• 依托单位: NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-03-01 至 2015-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8136431
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Acute; Address; Adopted; Antibodies; Area; Attitude; Awareness; Behavioral; Caring; Clinic; Clinical; Communities; Community Healthcare; Consultations; Country; Detection; Development; Diagnosis; Diagnostic tests; Early treatment; Educational workshop; Epidemiology; HIV; HIV Antibodies; HIV Infections; Health; Healthcare; Human immunodeficiency virus test; Incidence; Individual; Infection; Institutes; International; Intervention; Knowledge; Measures; Medical; Mental Health; Modeling; New York City; Outcome Study; Patients; Persons; Play; Policies; Prevalence; Primary Health Care; Professional counselor; Provider; Public Health; Resources; Risk; Risk Behaviors; Role; Screening procedure; Site; Staging; Symptoms; Test Result; Testing; Thinking; Time; Training; Training and Infrastructure; Translational Research; Translations; Viral; Viral Load result; Work; antiretroviral therapy; base; clinical practice; comparative effectiveness; experience; flu; improved; innovation; primary outcome; programs; routine practice; scale up; secondary outcome; symposium; tool; transmission process

DESCRIPTION (provided by applicant): Acute HIV Infection (AHI) - the 10-week period after HIV-infection before antibodies are produced but when viral load is extremely high - plays a critical role in HIV transmission: as many as half of all new HIV infections may be attributable to transmission from an acutely infected person. Current policy and practice for routine HIV testing uses the HIV-antibody test, thus providing negative test results to acutely infected individuals precisely when they are at least 10 times as infectious as at later stages. Yet, those diagnosed with AHI often reduce their risk behaviors, thereby reducing rapid HIV transmission; and early treatment for AHI has short- and long-term individual clinical benefit. Test-and-Treat approaches to HIV prevention are based on expanded HIV-antibody testing combined with antiretroviral therapy to lower viral load. This strategy will be compromised if measures are not taken to improve detection of AHI. Yet, primary (non-HIV) care providers are often not aware of AHI or trained to screen for risk status and order diagnostic tests. Similarly, HIV test counselors are not trained to screen for AHI symptoms or to make warranted referrals for testing. Finally, primary healthcare clinics do not have the tools necessary to adopt structural changes necessary to optimize detection of AHI. To address this evolving public health challenge, this study proposes to develop and evaluate an innovative multi-level, multi-component, structural intervention (implemented at the level of the clinic) to promote routine screening and appropriate testing for AHI by medical care providers HIV-test counselors, and among their patients. The study will compare a "Basic Intervention" to an "Enhanced Intervention" to determine how intensive the intervention needs to be and what resources would be needed for widespread scale-up and dissemination. The study will be conducted in areas of high HIV incidence and prevalence in Bronx, NY by three collaborating partners: The HIV Center for Clinical and Behavioral Studies at the NY State Psychiatric Institute, the NY State Department of Health, AIDS Institute, and the NYC Department of Health and Mental Hygiene. There will also be involvement of local clinical and community stakeholders. Thus this innovative structural intervention has the potential to influence policy at the level of medical care clinics and in directives and guidance from national, state, and local Institutes and Departments of Health, which can in turn, have a large impact on HIV epidemiology, particularly in settings of high HIV incidence, domestically and internationally. PUBLIC HEALTH RELEVANCE: There is compelling evidence that acute HIV infection (AHI) plays a critical role in HIV transmission, because it is a period of time after infection when a person is highly infectious but before antibodies can be detected. As many as half of all new cases of HIV may be due to transmission during this period when the person does not know he/she is infected, and when the person can benefit from early treatment. Thus, increasing detection of AHI in communities of high HIV prevalence and incidence carries significant potential benefits for both the public and individual health.

描述（由申请人提供）：急性HIV感染（AHI） - 产生抗体前的HIV感染后的10周期间，但是当病毒载荷极高时 - 在HIV传播中起关键作用：所有新的HIV感染中多达一半可能归因于急性感染者的传播。当前的常规艾滋病毒测试的政策和实践采用了HIV抗体测试，从而为急性感染的个体提供了阴性测试结果，而当他们至少具有至少10倍的感染力，就像后期阶段一样。然而，那些被诊断出患有AHI的人经常减少其风险行为，从而减少快速HIV传播。 AHI的早期治疗具有短期和长期的个人临床益处。预防HIV的测试和治疗方法是基于扩展的HIV抗体测试，结合了抗逆转录病毒疗法以降低病毒载量。如果未采取措施改善AHI的检测，将损害此策略。然而，初级（非HIV）护理提供者通常不知道AHI或经过培训以筛选风险状态和订单诊断测试。同样，艾滋病毒测试辅导员也没有接受筛查AHI症状的培训或进行测试的保证转介。最后，初级医疗保健诊所没有必要的工具来采用优化AHI检测所需的结构性变化。为了应对这一不断发展的公共卫生挑战，本研究建议开发和评估创新的多层次，多组分，结构干预措施（在诊所水平上实施），以促进医疗保健提供者HIV检验咨询师及其患者的常规筛查和适当的AHI测试。该研究将将“基本干预措施”与“增强的干预措施”进行比较，以确定干预措施的密集程度以及广泛扩大和传播所需的资源。该研究将在纽约州布朗克斯的高艾滋病毒发病率和流行率的领域由三个合作伙伴：纽约州立精神病学研究所，纽约州卫生部，艾滋病研究所和纽约市卫生与卫生和精神卫生部的艾滋病毒临床和行为研究中心进行。当地临床和社区利益相关者也将参与其中。因此，这种创新的结构干预措施有可能影响医疗诊所的政策，以及来自国家，州和地方机构和卫生部门的指令和指导，这反过来又可能对HIV流行病学产生重大影响，尤其是在领地高艾滋病毒的情况下，在国内和国际上。 公共卫生相关性：有令人信服的证据表明，急性艾滋病毒感染（AHI）在艾滋病毒传播中起着至关重要的作用，因为这是感染后的一段时间，当时一个人具有高度感染力，但在检测到抗体之前。在所有新的艾滋病毒案件中，多达一半的艾滋病毒可能是由于此期间不知道他/她被感染的，以及该人可以从早期治疗中受益时的传播。因此，增加艾滋病毒率和发病率的社区对AHI的发现为公众和个人健康带来了巨大的潜在利益。