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

新型筛查计划对检测急性和流行的艾滋病毒感染并减少艾滋病毒传播的影响

基本信息

批准号：
9336791
负责人：
Susan Marie Graham
金额：
$ 57.26万
依托单位：
UNIVERSITY OF WASHINGTON
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-08-24 至 2020-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9336791
关键词：
AIDS prevention Acute Address Adult Africa South of the Sahara African Algorithms Anti-Retroviral Agents Antigens Caring Cessation of life Clinical Consensus Cost Effectiveness Analysis Counseling Country Coupled Data Detection Development Diagnosis Diagnostic tests Disease Outbreaks Early Diagnosis Epidemic Evaluation Fever Foundations HIV HIV Infections HIV diagnosis HIV-1 Health Health Benefit Health care facility Healthcare Systems High Prevalence Human immunodeficiency virus test Individual Infection Interdisciplinary Study Intervention Kenya Lead Link Malaise Malaria Medical Medical Research Modeling Newly Diagnosed Notification Outcome Partner Notification Patients Persons Policies Prevention Prevention program Prevention strategy Preventive Intervention Privatization Provider Public Health RNA Research Research Institute Research Project Grants Resources Risk Risk Behaviors Risk Reduction Services Symptoms Syndrome Testing Universities Viral Load result Washington Work antiretroviral therapy base care seeking case finding clinical care cost cost effective cost effectiveness design disability-adjusted life years editorial efficacy testing experience high risk behavior improved indexing innovation interdisciplinary approach novel point of care pre-exposure prophylaxis programs public health emergency screening seropositive service intervention standard of care transmission process uptake virology young adult

项目摘要

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.

项目摘要急性艾滋病毒感染（AHI）的检测和管理是临床和公共卫生紧急情况，艾滋病毒通常是最近诊断出的年轻人感染。最近获得HIV的年轻人经常寻求护理症状，并有可能通过医疗保健系统诊断出来。尽管超过50％的肯尼亚感染艾滋病毒感染的人没有意识到自己的地位，但基于设施的艾滋病毒测试未充分利用，可用测试无法诊断AHI。艾滋病毒感染的早期识别提供可观的个人和公共卫生益处，包括降低风险行为，在如果实现艾滋病毒测试，获得咨询和治疗的机会以及抑制病毒负荷。在此R01中应用程序，我们提出了一个跨学科研究项目，该项目以沿海地区进行的试点工作为基础肯尼亚在年轻人中发现AHI，以寻求护理与急性逆转录病毒兼容的症状综合征。我们高产的研究团队，包括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拥有专业知识（博士 Graham），HIV预防（桑德斯博士），合作伙伴咨询和通知服务（Farquhar博士），风险行为和网络评估（Goodreau博士）和干预成本（Babigumira博士）。我们的具体目的是：（1）通过我们的AHI筛选算法确定并测试1,500名成人急性和普遍（即血清阳性）艾滋病毒，将所有新诊断的HIV感染患者联系起来，以立即护理和提供治疗; （2）向所有检测到的情况提供辅助合作伙伴通知服务（APS），筛选合作伙伴急性和普遍的艾滋病毒感染并确定局部性网络；（3）建模这两种干预措施对肯尼亚艾滋病毒的流行，估计每只艾滋病毒感染的增量成本，避免了，使用有关我们创新计划的结果的数据，避免了死亡，避免了残疾调整的生命年。我们将使用修改后的梯形楔形设计来评估2个公众的筛查干预措施的产量肯尼亚沿海沿海的4个私人卫生设施，干预之前和之后。我们的创新性干预将使用标准的HIV快速测试来诊断普遍的HIV感染和护理点HIV-1 RNA 测试以诊断为护理的年轻人中的AHI；使用APS识别链接的急性和普遍感染；并关注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，ART启动和艾滋病毒感染患者的病毒学抑制和病毒学抑制的结果，并准备不感染的个人与不一致的伙伴关系的吸收。在我们的AHI筛选的飞行员工作的基础上建立（ClinicalTrials.gov，NCT01876199）以及我们在肯尼亚的APS的开创性工作（ClinicalTrials.gov， NCT01616420），以及我们在建模和成本效益分析方面的专业知识，我们将提供关于这部小说的潜力，HIV预防干预的潜力的基础数据，以显着降低在肯尼亚和其他高额非洲环境中正在进行的艾滋病毒传播。