Primary HIV Infection: the Public Health Perspective

描述(由申请人提供)：当艾滋病毒感染的一级预防效果低于100%时，二级预防应将未诊断的艾滋病毒阳性者纳入咨询、检测和治疗计划，以减少向伴侣的传播。原发艾滋病毒感染(PHI)是发现艾滋病毒感染的最早时期，如果它占传播的大多数，增加对PHI的认识可能对限制艾滋病毒流行的传播产生最大影响。 在目标1中，我们建议实施一项公共卫生运动，向高危人群传授PHI的症状，并指导他们在出现这些症状时在选定的地点进行检测。调查将确定目标人群是否看到了活动，了解了内容，以及这种学习是否持续。我们将通过泊松和时间序列分析，比较教育活动前后通过公共卫生测试诊断出患有PHI的人数。成本效益分析将评估每个被诊断为PHI的人的计划成本。最后，我们假设，转诊到西雅图初级感染诊所(PIC)的人数的增加将进一步证明承认PHI的教育活动的好处。 AIM#2，PIC合作伙伴研究，是一个更大的合作的一部分，在过去的12年里，该合作招募了260多名PHI患者参加研究。新PIC参与者的伴侣将接受艾滋病毒感染筛查，并将完成临床和行为问卷。将通过病毒测序确认传播(源)伴侣，并将进行病例对照研究，以量化传播(病例)与非传播(对照)HIV阳性伴侣精浆病毒血症相关的传播几率。 这些公共卫生倡议项目将解决与识别事件感染、有助于传播和获取的伙伴关系因素以及计划评估有关的新问题。在此过程中，该奖项将为首席调查员提供公共卫生教育方法、成本效益和统计分析以及临床研究方面的学习机会和职业发展。

DESCRIPTION (provided by applicant): When primary prevention for HIV infection is less than 100% effective, secondary prevention should incorporate undiagnosed HIV-positive individuals into counseling, testing, and treatment programs to reduce transmission to partners. Primary HIV infection (PHI) is the earliest period to detect HIV infection, and, if it accounts for the majority of transmission, increasing recognition of PHI could have the greatest impact on limiting the spread of the HIV epidemic. In Aim #1, we propose to implement a public health campaign to teach the symptoms of PHI to high-risk individuals and to instruct them to seek testing at selected sites if they develop those symptoms. Surveys will ascertain whether the target population saw the campaign, learned the content, and whether that learning was sustained. We will compare, by Poisson and time series analysis, the number of individuals diagnosed with PHI by public health testing before and after the educational campaign. A cost-effectiveness analysis will assess the cost of the program per individual diagnosed with PHI. Finally, we hypothesize that an increase in referrals to the Seattle Primary Infection Clinic (PIC) will provide further evidence of the benefit of the educational campaign on recognition of PHI. Aim #2, the PIC Partners Study, is part of a larger collaboration that has enrolled over 260 individuals with PHI into research studies over the last 12 years. Partners of new PIC enrollees will be screened for HIV infection and will complete a clinical and behavioral questionnaire. Transmitting (source) partners will be confirmed by viral sequencing, and a case-control study will be performed to quantify the odds of transmission associated with seminal plasma viremia in transmitting (case) versus non-transmitting (control) HIV-positive partners. These PHI projects will address novel issues related to recognition of incident infection, partnership factors contributing to transmission and acquisition, and program assessment. In the process, this award will provide learning opportunities and career development for the Principal Investigator in public health education methodology, cost-effectiveness and statistical analysis, and clinical research.