Network-Directed Community Screening for HIV

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。我们建议测试这样一个概念，即网络知情的社区筛查可以在艾滋病毒传播高风险的社区进行。我们将比较三种网络方法——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的特征。潜在的假设是，基于网络的方法将有效地发现高危人群，因为这些人彼此之间的接近性和相互关联的可能性。特别是，这些方法将发现那些不知道自己感染的人（估计约占感染者的20%），他们可能因此不成比例地促进传播。在社区中发现感染具有相当大的预防潜力。越来越多的证据表明，对艾滋病毒阳性状况的简单认识可能会减少高风险行为。此外，更广泛地使用抗逆转录病毒疗法有可能减少传播。最后，这种发现允许对高危人群更广泛地应用特定（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三个相似但地理上不同的社区，这些社区已知有艾滋病毒负担。我们将在每个社区使用一种网络方法，通过简短问卷和快速口服艾滋病毒检测进行筛查。那些检测呈阳性的人将被转介到艾滋病临床提供者进行确认和进一步的诊断和临床检查。检测结果为阴性的人将被要求提供血液样本进行抗原检测，以诊断急性艾滋病毒感染。分析将侧重于确定不知道自己感染的艾滋病毒阳性患者的比例；这些社区的发病率和流行率；并分析了三种抽样方法所观察到的网络的异同。我们建议在两年的项目中筛选1000人。

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.