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，预防艾滋病毒/艾滋病的设施有所扩大。社会态度的改变--艾滋病“例外论”的减弱--现在允许采取更激进的方法。我们建议测试这一概念，即基于网络的社区筛查可以在艾滋病毒传播的高风险社区进行。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特征。潜在的假设是，网络信息方法将有效地发现高危人群，因为这些人彼此之间的亲近性和可能性。特别是，这些方法将发现那些没有意识到自己感染的人(估计约占感染者的20%)，因此他们可能对传播起到不成比例的作用。在社区中发现感染具有相当大的预防潜力。已有证据表明，对艾滋病毒阳性状态的简单认识可能会减少高危行为。此外，通过更广泛地使用抗逆转录病毒治疗，有可能减少传播。最后，这种发现允许对高危人群更多地应用特定(艾滋病毒咨询和行为改变)和非特定(药物治疗)措施。我们的研究计划集中在亚特兰大市三个相似但地理上不同的社区，这些社区都有已知的艾滋病毒负担。我们将在每个社区使用一种网络方法，用一份简短的问卷进行筛查，并对艾滋病毒进行快速口头测试。测试呈阳性反应的患者将被转介至艾滋病临床提供者进行确认，并进行进一步的诊断和临床检查。测试呈阴性反应的人士将被要求提供血液样本进行抗原测试，以诊断急性艾滋病毒感染。分析将侧重于确定艾滋病毒阳性者不知道其感染的比例；这些社区的疾病发病率和流行率；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对1000人进行筛查。 与公共健康相关：一种基于街道、网络驱动的疾病筛查方法，消除了传统既定地点(诊所、军事设施等)的筛查过程并将其置于潜在的传播点。如果这种方法能够被证明是一个有效的概念，并随后被一个广泛的示范计划所验证，它将大大增加预防和控制艾滋病毒/艾滋病的设施。