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)——HIV 感染后 10 周，抗体产生之前，但此时病毒载量极高——在 HIV 传播中发挥着关键作用：多达一半的新感染者HIV 感染可能是由急性感染者传播的。目前常规 HIV 检测的政策和实践使用 HIV 抗体检测，从而在急性感染者的传染性至少是后期阶段的 10 倍时为他们提供阴性检测结果。然而，被诊断患有 AHI 的人往往会减少危险行为，从而减少艾滋病毒的快速传播； AHI 的早期治疗具有短期和长期的个体临床益处。预防艾滋病毒的检测和治疗方法基于扩大艾滋病毒抗体检测与抗逆转录病毒治疗相结合以降低病毒载量。如果不采取措施改进 AHI 检测，这一策略就会受到影响。然而，初级（非艾滋病毒）护理提供者通常不了解 AHI，也不接受过筛查风险状态和订购诊断测试的培训。同样，HIV 检测顾问也没有接受过筛查 AHI 症状或推荐检测的培训。最后，初级卫生保健诊所没有必要的工具来采取必要的结构改变来优化 AHI 的检测。为了应对这一不断变化的公共卫生挑战，本研究建议开发和评估创新的多层次、多成分、结构性干预措施（在诊所层面实施），以促进医疗保健提供者对 AHI 进行常规筛查和适当检测。 -测试辅导员及其患者。该研究将比较“基本干预”和“强化干预”，以确定干预需要的强度以及广泛扩大和传播需要哪些资源。该研究将由三个合作伙伴在纽约州布朗克斯的艾滋病毒高发地区进行：纽约州精神病学研究所的艾滋病毒临床和行为研究中心、纽约州卫生部、艾滋病研究所和纽约市健康和心理卫生部。当地临床和社区利益相关者也将参与其中。因此，这种创新的结构性干预措施有可能影响医疗诊所层面的政策以及国家、州和地方卫生机构和部门的指令和指导，进而对艾滋病毒流行病学产生巨大影响，特别是在国内和国际艾滋病毒高发地区。 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，因为这是感染后一个人具有高度传染性但在抗体可以检测到之前的一段时间。多达一半的艾滋病毒新发病例可能是由于这一时期的传播造成的，此时该人不知道自己已被感染，并且该人可以从早期治疗中受益。因此，在艾滋病毒流行率和发病率高的社区中增加 AHI 的检测，对公众和个人健康都具有巨大的潜在好处。