Structural Intervention to Increase Screening and Testing for Acute HIV Infection

描述（由申请人提供）：急性HIV感染（AHI）——HIV感染后抗体产生前的10周时间，但此时病毒载量极高——在HIV传播中起着关键作用：多达一半的新HIV感染可能归因于急性感染者的传播。目前常规艾滋病毒检测的政策和做法使用艾滋病毒抗体检测，因此，当急性感染者的传染性至少是后期阶段的10倍时，他们的检测结果恰好为阴性。然而，那些被诊断为AHI的人往往会减少他们的危险行为，从而减少HIV的快速传播；早期治疗AHI具有短期和长期的个体临床益处。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。如果不采取措施改善AHI的检测，这一策略将受到损害。然而，初级（非艾滋病毒）保健提供者往往不了解AHI或接受过筛查风险状况和安排诊断测试的培训。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用必要的结构变化来优化AHI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一种创新的多层次、多组分、结构性干预（在诊所层面实施），以促进医疗保健提供者hiv检测顾问及其患者对AHI进行常规筛查和适当检测。这项研究将比较“基本干预”和“强化干预”，以确定干预的强度，以及需要哪些资源来广泛扩大和传播。该研究将由三个合作伙伴在纽约州布朗克斯区的艾滋病毒高发和流行地区进行：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卫生和心理卫生部。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令和指导，进而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高发病率的环境中。

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.