Impact of a novel screening program to detect acute and prevalent HIV infection and reduce HIV transmission

项目摘要 急性HIV感染（AHI）的检测和管理是一种临床和公共卫生紧急情况， 年轻人中确诊的感染通常是最近发生的。最近感染艾滋病毒的年轻人 经常寻求治疗的症状，并可能通过医疗保健系统诊断。 虽然肯尼亚超过50%的艾滋病毒感染者不知道自己的状况，但设施内的艾滋病毒感染者 测试是利用不足，现有的测试不能诊断AHI。及早发现艾滋病毒感染， 相当大的个人和公共卫生效益，包括减少危险行为，通知合作伙伴， 艾滋病毒检测的需要，获得咨询和治疗，以及病毒载量抑制，如果实现。在此R 01 应用，我们提出了一个多学科的研究项目，建立在沿海地区开展的试点工作， 肯尼亚将在寻求与急性逆转录病毒相一致的症状的年轻人中检测AHI 综合征我们的高效率研究团队，包括来自华盛顿大学的合作者， 牛津大学和肯尼亚医学研究所，在临床护理领域的专业知识（博士。 格雷厄姆），艾滋病毒预防（桑德斯博士），伴侣咨询和通知服务（法夸尔博士），风险 行为和网络评估（Goodreau博士），以及干预措施的成本（Babigumira博士）。我们的具体 目的是：（1）确定和测试1,500名成年人通过我们的AHI筛查算法确定的急性和流行性 (i.e.,艾滋病毒，将所有新诊断的艾滋病毒感染者与护理联系起来， 治疗;（2）向所有发现的病例提供协助性伙伴通知服务， 急性和流行的艾滋病毒感染，并确定当地的性网络;和（3）模型的潜在影响， 这两项针对肯尼亚艾滋病毒流行病的干预措施，估计每避免一次艾滋病毒感染的增量成本， 避免了死亡，避免了残疾调整生命年，使用我们创新计划的结果数据。 我们将使用改良的阶梯式楔形设计，在2个公共场所评估这种筛查干预的效果。 和肯尼亚沿海的4个私人卫生设施，在干预措施实施前后。我们的创新 干预措施将使用标准的艾滋病毒快速检测来诊断流行的艾滋病毒感染， 检测以诊断就诊的年轻人中的AHI;使用aPS来识别相关的急性和流行性 感染;并跟踪所有新诊断的患者及其伴侣12个月，以确定临床 结果包括与护理的联系，HIV感染患者的ART启动和病毒学抑制，以及PrEP 在不和谐的伙伴关系中未感染个体的摄取。在我们的AHI筛查试点工作的基础上， （Clinicaltrials.gov，NCT 01876199）和我们在肯尼亚的aPS开创性工作（Clinicaltrials.gov， NCT 01616420），以及我们在建模和成本效益分析方面的专业知识，我们将提供 关于这种新型的联合艾滋病毒预防干预措施的潜力的基础数据， 艾滋病毒在肯尼亚和非洲其他高流行率地区的持续传播。

Project Summary Detection and management of acute HIV infection (AHI) is a clinical and public health emergency, and HIV infections diagnosed among young adults are usually recent. Young adults with recent HIV acquisition frequently seek care for symptoms, and could potentially be diagnosed through the health care system. Although over 50% of persons living with HIV infection in Kenya are unaware of their status, facility-based HIV testing is underutilized and available tests cannot diagnose AHI. Early recognition of HIV infection provides considerable individual and public health benefits, including reduction in risk behavior, notification of partners in need of HIV testing, access to counseling and treatment, and viral load suppression, if achieved. In this R01 application, we propose a multidisciplinary research project that builds on pilot work carried out in coastal Kenya to detect AHI among young adults seeking care for symptoms compatible with acute retroviral syndrome. Our highly productive research team, including collaborators from the University of Washington, University of Oxford, and Kenya Medical Research Institute, has expertise in the fields of clinical care (Dr. Graham), HIV prevention (Dr. Sanders), partner counseling and notification services (Dr. Farquhar), risk behavior and network evaluations (Dr. Goodreau), and costing of interventions (Dr. Babigumira). Our specific aims are to: (1) identify and test 1,500 adults identified by our AHI screening algorithm for acute and prevalent (i.e., seropositive) HIV, linking all newly diagnosed HIV-infected patients to care and offering immediate treatment; (2) offer assisted partner notification services (aPS) to all cases detected, screening partners for acute and prevalent HIV infection and identifying local sexual networks; and (3) model the potential impact of these two interventions on the Kenyan HIV epidemic, estimating incremental costs per HIV infection averted, death averted, and disability-adjusted life-year averted using data on outcomes from our innovative program. We will use a modified stepped wedge design to evaluate the yield of this screening intervention at 2 public and 4 private health facilities in coastal Kenya, before and after intervention delivery. Our innovative intervention will use standard HIV rapid tests to diagnose prevalent HIV infection and point-of-care HIV-1 RNA testing to diagnose AHI among young adults presenting for care; use aPS to identify linked acute and prevalent infections; and follow all newly diagnosed patients and their partners for 12 months to ascertain clinical outcomes including linkage to care, ART initiation and virologic suppression in HIV-infected patients, and PrEP uptake in uninfected individuals in discordant partnerships. Building on our pilot work on AHI screening (Clinicaltrials.gov, NCT01876199) and our ground-breaking work on aPS in Kenya (Clinicaltrials.gov, NCT01616420), as well as our expertise in modeling and cost-effectiveness analysis, we will provide foundational data on the potential of this novel, combination HIV prevention intervention to significantly reduce ongoing HIV transmission in Kenya and other high-prevalence African settings.