Structural Intervention to Increase Screening and Testing for Acute HIV Infection

描述(由申请人提供)：急性艾滋病毒感染(AHI)--艾滋病毒感染后10周，抗体产生之前，但病毒载量极高的时期--在艾滋病毒传播中起着关键作用：多达一半的新艾滋病毒感染可能归因于急性感染者的传播。目前的艾滋病毒常规检测政策和做法使用艾滋病毒抗体检测，从而在传染性至少是后期的10倍时，准确地向急性感染者提供阴性检测结果。然而，那些被诊断为AHI的人通常会减少他们的危险行为，从而减少艾滋病毒的快速传播；早期治疗AHI对个人临床有短期和长期的好处。艾滋病毒预防的检测和治疗方法是基于扩大艾滋病毒抗体检测并结合抗逆转录病毒疗法来降低病毒载量。如果不采取措施改善对AHI的检测，这一战略将受到损害。然而，初级(非艾滋病毒)护理提供者往往不知道AHI，也没有接受过筛查风险状态和安排诊断测试的培训。同样，艾滋病毒检测顾问没有接受过筛查AHI症状或进行有根据的转介进行检测的培训。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变化来优化AHI的检测。为了应对这一不断演变的公共卫生挑战，本研究建议开发和评估一种创新的多层次、多组成部分的结构性干预措施(在诊所层面实施)，以促进医疗保健提供者、艾滋病毒检测顾问及其患者对AHI进行常规筛查和适当的检测。这项研究将比较“基本干预”和“强化干预”，以确定干预需要多大程度，以及需要什么资源才能广泛扩大和传播。这项研究将在纽约州布朗克斯市艾滋病毒发病率和流行率较高的地区由三个合作伙伴进行：纽约州立精神病学研究所的艾滋病毒临床和行为研究中心、纽约州立卫生局、艾滋病研究所和纽约市卫生和心理卫生局。还将有当地临床和社区利益攸关方的参与。因此，这一创新的结构性干预措施有可能影响医疗诊所一级的政策以及国家、州和地方卫生机构和部门的指示和指导，这反过来又可能对艾滋病毒流行病学产生重大影响，特别是在国内和国际艾滋病毒发病率高的情况下。

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.