Network-Directed Community Screening for HIV

网络指导的艾滋病毒社区筛查

• 批准号: 8092682
• 负责人: RICHARD B ROTHENBERG
• 金额: $ 18.57万
• 依托单位: GEORGIA STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-07-01 至 2013-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8092682
• 关键词: AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Acute; Antigens; Attitude; Awareness; Behavioral; Blood specimen; Caring; Centers for Disease Control and Prevention (U.S.); Characteristics; Chronic; Cities; Clinic; Clinical; Communities; Counseling; Diagnosis; Diagnostic; Disease; Drug usage; Evaluation; Geographic Distribution; Geographic Locations; HIV; HIV Infections; HIV Seropositivity; Healthcare; Human immunodeficiency virus test; Incidence; Infection; Intervention; Life; Link; Measures; Methods; Military Personnel; Neighborhoods; Network-based; Oral; Pattern; Persons; Pharmaceutical Preparations; Policies; Positioning Attribute; Prevalence; Prevention; Preventive; Probability; Process; Provider; Public Health; Questionnaires; RNA; Recommendation; Research; Respondent; Risk; Sampling; Scheme; Screening procedure; Sex Behavior; Site; Social Change; Structure; Testing; United States; Validation; antiretroviral therapy; attenuation; base; cost; density; high risk; high risk behavior; inner city; programs; public health relevance; transmission process

DESCRIPTION (provided by applicant): The preventive armamentarium against HIV/AIDS has enlarged in recent years. Changing social attitudes-an attenuation of AIDS "exceptionalism"-now permit more aggressive approaches. We propose to test the concept that network-informed community-based screening can be performed in neighborhoods at high risk for HIV transmission. We will compare three network methods-snowball sampling, chain-link sampling, and respondent driven sampling (RDS)-with regard to the "yield" of HIV- positive persons, the characteristics of these persons, and the characteristics of the networks that emerge from these sampling schemes. The underlying hypothesis is that network-informed methods will efficiently find persons at high risk because of these persons' propinquity and probability of relating to each other. In particular, these approaches will discover persons who are unaware of their infection (estimate to be about 20% of those infected) and who may therefore contribute disproportionately to transmission. Discovery of infection in a community has considerable potential for prevention. Evidence has accrued that simple awareness of HIV-positivity status may reduce high risk behavior. In addition, there is a potential to reduce transmission by more widespread use of antiretroviral therapy. Finally, such discovery permits greater application of specific (HIV counseling and behavioral change) and non-specific (drug treatment) measures to persons at high risk. Our research plan focuses on three similar but geographically distinct, communities in the city of Atlanta with a known burden of HIV. We will use one of the network approaches in each of the communities, screening with a brief questionnaire, and a rapid oral test for HIV. Those who test positive will be referred to an AIDS clinical provider for confirmation and further diagnostic and clinical workup. Persons who test negative will be requested to provide a blood specimen for antigen testing to diagnose acute HIV infection. The analysis will focus on defining the proportion of HIV-positive persons who were unaware of their infection; on the incidence and prevalence of disease in these communities; and on the differences and similarities of the networks observed by the three sampling methods. We propose to screen 1,000 persons during the two years of the project. PUBLIC HEALTH RELEVANCE: A street-based, network-driven approach to disease screen removes the screening process from traditional established sites (clinics, military installations, etc.) and places it at the point of potential transmission. If such an approach can be demonstrated to be a valid concept, and is subsequently verified by a broad-based demonstration program, it will add significantly to the armamentarium for prevention and control of HIV/AIDS.

描述（由申请人提供）：近年来，针对艾滋病毒/艾滋病的预防措施不断扩大。 社会态度的改变——艾滋病“例外论”的减弱——现在允许采取更积极的方法。 我们建议测试可以在艾滋病毒传播高风险社区进行基于网络的社区筛查的概念。 我们将比较三种网络方法——滚雪球抽样、链式抽样和受访者驱动抽样（RDS）——关于艾滋病毒阳性者的“产量”、这些人的特征以及从这些抽样方案中产生的网络的特征。 基本假设是，基于网络的方法将有效地找到高风险人群，因为这些人的距离很近并且彼此相关的可能性很大。 特别是，这些方法将发现那些不知道自己被感染的人（估计约占感染者的 20%），因此可能对传播造成不成比例的影响。 在社区中发现感染具有相当大的预防潜力。 越来越多的证据表明，简单地了解艾滋病毒阳性状况可能会减少高危行为。 此外，更广泛地使用抗逆转录病毒疗法有可能减少传播。 最后，这样的发现允许对高危人群更多地应用特定的（艾滋病毒咨询和行为改变）和非特定的（药物治疗）措施。 我们的研究计划重点关注亚特兰大市三个相似但地理位置不同的已知艾滋病毒负担的社区。 我们将在每个社区使用一种网络方法，通过简短的调查问卷进行筛查，并对艾滋病毒进行快速口腔检测。 检测呈阳性的人将被转介至艾滋病临床提供者处进行确认以及进一步的诊断和临床检查。 检测呈阴性的人士将被要求提供血液样本进行抗原检测，以诊断急性艾滋病毒感染。 分析的重点是确定不知道自己感染的艾滋病毒阳性者的比例；这些社区的疾病发生率和流行情况；以及三种抽样方法观察到的网络的异同。 我们建议在该项目的两年内筛查 1,000 人。 公共卫生相关性：基于街道、网络驱动的疾病筛查方法消除了传统场所（诊所、军事设施等）的筛查过程，并将其置于潜在传播点。 如果这种方法能够被证明是一个有效的概念，并随后通过基础广泛的示范计划得到验证，它将大大丰富预防和控制艾滋病毒/艾滋病的装备。