The Efficacy and Impact of Routine HIV and TB Testing in Durban, South Africa

描述（由申请人提供）：南非目前有更多的艾滋病毒感染的公民比世界上任何其他国家。查明艾滋病毒感染者和迅速发现结核病合并感染，对于改善获得治疗的机会、降低发病率和控制这一流行病的蔓延至关重要。尽管政府推广免费自愿咨询和检测（VCT）站点，并且几乎普遍提供抗逆转录病毒疗法，但只有五分之一的南非人知道VCT站点已经过检测。候选人试图评估这样一种假设，即常规艾滋病毒检测将增加麦考德医院的检测率和与护理的联系。麦考德医院是南非艾滋病毒流行率最高的省份德班的一个城市中心。提出了四个相互关联的具体目标：1）评估门诊部（OPD）新建立的常规HIV检测计划，以检查患者接受程度、HIV流行率和阶段、与护理的联系以及拒绝检测的原因，2）将常规HIV检测扩展到住院医疗服务，以检查目标1中概述的参数，并将其与门诊设置中的参数进行比较，3）使用合并的HIV血浆RNA检测来诊断急性HIV感染，并估计紧急护理和住院环境中的HIV发病率，以及4）评估新诊断HIV患者的普遍痰结核筛查的产量。候选人将获得流行病学和生物统计学基础，通过哈佛公共卫生学院的课程，并通过2名具有培养初级研究者的良好记录的高级临床研究者的指导，实现这些目标。这项工作实现了NIH艾滋病研究办公室提出的目标，包括建立国际队列以进一步开展艾滋病毒预防研究，评估干预措施对艾滋病毒相关结果的影响，以及促进美国科学家与发展中国家同行之间的科学合作。常规艾滋病毒检测有可能减少耻辱感，提高对艾滋病毒检测的接受程度，并增加艾滋病毒感染者和护理人员的数量。该项目的研究和教学方面的完成将为候选人提供从传染病研究员过渡到国际艾滋病毒护理领域的独立临床研究员的经验。

DESCRIPTION (provided by applicant): South Africa currently has more HIV infected citizens than any other country in the world. Identification of HIV-infected individuals and rapid detection of tuberculosis co-infection is paramount for improving access to treatment, decreasing morbidity, and controlling the spread of the epidemic. Despite promotion of free voluntary counseling and testing (VCT) sites by the government and the near universal offer of antiretroviral therapy, only 1 in 5 South Africans aware of VCT sites have been tested. The candidate seeks to evaluate the hypothesis that routine HIV testing will increase testing uptake and linkage to care at McCord Hospital, an urban center in Durban in the South African province with the highest HIV prevalence. Four interrelated specific aims are proposed: 1) To evaluate a newly established routine HIV testing program in the Outpatient Department (OPD) to examine level of patient acceptance, HIV prevalence and stage, linkage to care and reasons for testing refusal, 2) To expand routine HIV testing to the inpatient medical service to examine the parameters outlined in Aim 1 and compare them to those in the outpatient setting, 3) To use pooled HIV plasma RNA testing to diagnose acute HIV infection and estimate HIV incidence in the urgent care and inpatient settings, and 4) To evaluate the yield of universal sputum tuberculosis screening for patients newly diagnosed with HIV. The candidate will gain the epidemiologic and biostatistical foundation to achieve these aims through coursework at the Harvard School of Public Health, and through the mentorship of 2 senior clinical investigators with strong records of cultivating junior investigators. This work fulfills goals stated by the NIH Office of AIDS Research, including creating international cohorts to further HIV prevention research, assessing the impact of interventions on HIV-related outcomes, and fostering scientific collaborations between American scientists and their counterparts in the developing world. Routine HIV testing has the potential to decrease stigma, increase acceptance of HIV testing, and increase the number of people identified with HIV infection and linked to care. Completion of the research and didactic aspects of this project will provide the candidate with the experience to make the transition from infectious disease fellow to independent clinical investigator in the field of international HIV care.