Structural Intervention to Increase Screening and Testing for Acute HIV Infection

加强急性艾滋病毒感染筛查和检测的结构性干预

• 批准号: 8136431
• 负责人: ROBERT H REMIEN
• 金额: $ 52.1万
• 依托单位: NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-03-01 至 2015-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8136431
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Acute; Address; Adopted; Antibodies; Area; Attitude; Awareness; Behavioral; Caring; Clinic; Clinical; Communities; Community Healthcare; Consultations; Country; Detection; Development; Diagnosis; Diagnostic tests; Early treatment; Educational workshop; Epidemiology; HIV; HIV Antibodies; HIV Infections; Health; Healthcare; Human immunodeficiency virus test; Incidence; Individual; Infection; Institutes; International; Intervention; Knowledge; Measures; Medical; Mental Health; Modeling; New York City; Outcome Study; Patients; Persons; Play; Policies; Prevalence; Primary Health Care; Professional counselor; Provider; Public Health; Resources; Risk; Risk Behaviors; Role; Screening procedure; Site; Staging; Symptoms; Test Result; Testing; Thinking; Time; Training; Training and Infrastructure; Translational Research; Translations; Viral; Viral Load result; Work; antiretroviral therapy; base; clinical practice; comparative effectiveness; experience; flu; improved; innovation; primary outcome; programs; routine practice; scale up; secondary outcome; symposium; tool; transmission process

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. PUBLIC HEALTH RELEVANCE: There is compelling evidence that acute HIV infection (AHI) plays a critical role in HIV transmission, because it is a period of time after infection when a person is highly infectious but before antibodies can be detected. As many as half of all new cases of HIV may be due to transmission during this period when the person does not know he/she is infected, and when the person can benefit from early treatment. Thus, increasing detection of AHI in communities of high HIV prevalence and incidence carries significant potential benefits for both the public and individual health.

描述（由申请人提供）：急性HIV感染（AHI）-HIV感染后产生抗体前的10周时间，但病毒载量极高-在HIV传播中起着关键作用：多达一半的新发HIV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，因此，当急性感染者的传染性至少是后期感染者的10倍时，检测结果为阴性。然而，那些被诊断患有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;并且AHI的早期治疗具有短期和长期的个体临床益处。检测和治疗艾滋病毒预防方法的基础是扩大艾滋病毒抗体检测，结合抗逆转录病毒疗法，以降低病毒载量。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）保健提供者往往不知道AHI，也没有受过筛查风险状况和安排诊断测试的培训。同样，艾滋病毒检测顾问也没有接受过筛查艾滋病毒感染症状或进行必要的转介检测的培训。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，以优化AHI的检测。为了应对这一不断发展的公共卫生挑战，本研究提出了开发和评估一种创新的多层次，多组件，结构性干预（在诊所的水平实施），以促进常规筛查和适当的测试AHI由医疗保健提供者艾滋病毒检测顾问，和他们的病人。该研究将比较“基本干预”和“强化干预”，以确定干预需要有多密集，以及广泛推广和传播需要哪些资源。这项研究将在纽约州布朗克斯的艾滋病毒高发病率和流行率地区进行，由三个合作伙伴进行：纽约州精神病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、州和地方卫生研究所和部门的指令和指导，这反过来又会对艾滋病毒流行病学产生巨大影响，特别是在国内和国际艾滋病毒高发病率的环境中。 公共卫生关系：有令人信服的证据表明，急性艾滋病毒感染（AHI）在艾滋病毒传播中起着关键作用，因为这是感染后的一段时间，当一个人具有高度传染性，但在抗体可以检测到。在所有艾滋病毒新病例中，多达一半的病例可能是由于在这段时间内传播的，当时这个人不知道他/她被感染了，而且这个人可以从早期治疗中受益。因此，在艾滋病毒流行率和发病率高的社区增加对艾滋病毒感染的检测，对公众和个人健康都有重大的潜在好处。