A Pilot of Intervention to Promote Acute HIV Testing by Ambulatory Care Providers

描述（由申请人提供）：拟议的研究将解决在旧金山弗朗西斯科的门诊护理医疗环境中急性HIV感染的识别。许多急性艾滋病毒感染者因急性逆转录病毒综合征的症状而寻求医疗护理，因为这些症状具有高度传染性。在医疗环境中诊断出的急性艾滋病毒感染将有助于早期发现艾滋病毒病例，并为减少艾滋病毒传播提供机会。然而，在门诊护理医疗环境中发现急性病例的现实可能性尚不清楚。在这一竞技场中，也没有对增加由艾滋病毒驱动的急性艾滋病毒诊断检测的战略进行测试。因此，我们建议开发和评估一种新的卫生服务干预措施的可行性和可接受性，特别是旨在提高门诊护理提供者对急性HIV感染的诊断。门诊急性艾滋病毒检测干预措施消除了在忙碌环境中进行急性艾滋病毒检测的障碍，方法是：利用教学培训和积极的社会营销战略，培训和激励提供者进行检测;采用快速和简单的算法进行急性艾滋病毒快速诊断;与患者合作，促进接受检测;以及使用新的联动支持干预来向患者披露积极结果并协调联动， 急性病例的随访。艾滋病毒/艾滋病咨询委员会干预措施的这些组成部分旨在促进急性艾滋病毒检测，并尽量减少检测对提供者的潜在负担，同时确保患者迅速与护理和预防服务联系起来。在一个为期3年的项目中，我们将实现三个具体目标：首先，我们将全面发展，完善和实施ATAC干预。由于干预措施将涉及影响卫生部门的新活动， 将根据这些关键利益攸关方的反馈，对这些活动的干预方案进行试点测试和完善。第二，我们将在一家大型公立医院门诊诊所的25名门诊护理提供者中进行一项为期一年的全面ATAC干预的试点研究，并测量ATAC干预下与干预前相比确定的急性艾滋病毒病例总数的变化。最后，我们将进行混合方法过程评估，从参与者和关键知情人那里获得关于具体干预组成部分的可行性、可接受性和感知价值的反馈。在项目完成后，我们将评估试点结果是否表明干预的可行性：在这种情况下，最终的干预措施将被手动用于全市ATAC艾滋病预防计划，其有效性将在一个更大的干预试验中进行评估。 公共卫生相关性：这项拟议中的研究将探索扩大对急性艾滋病毒感染患者的识别，当他们出现“流感样”疾病时，将他们诊断为在旧金山弗朗西斯科提供医疗服务的诊所。我们提出 对一项卫生服务干预战略进行试点测试，该战略将培训、激励和支持门诊护理诊所提供人员，对患有流感样疾病的高危患者进行急性艾滋病毒感染检测。加强对急性艾滋病毒感染的识别是国家艾滋病毒预防战略的一个重要目标，因为这些患者在急性疾病期间特别具有传染性。因此，该项目将提供重要信息，指导地方和国家执行该战略。

DESCRIPTION (provided by applicant): The proposed research will address the identification of acute HIV infections in ambulatory care medical settings in San Francisco. Many acutely HIV infected individuals seek medical care for symptoms of the acute retroviral syndrome, when they are highly infectious. Acute HIV infections diagnosed in medical settings would contribute both to earlier HIV case identification and opportunities to reduce HIV transmission. However, the real-world potential for acute case finding in ambulatory care medical settings is not known. Strategies for increasing symptoms-driven acute HIV diagnostic testing have also not been tested in this arena. We therefore propose to develop and evaluate the feasibility and acceptability of a novel health services intervention, specifically designed to increase the diagnosis of acute HIV infection by ambulatory care providers. The Acute HIV Testing in Ambulatory Care (ATAC) intervention addresses barriers that exist to performing acute HIV testing in the busy setting by: training and motivating providers to test, using both didactic training and an active social marketing strategy; introducing fast and simple algorithms for rapid acute HIV diagnosis; working with patients to promote acceptance of testing; and using a novel linkage support intervention to disclose positive results to patients and to coordinate linkage and follow-up of acute cases. Together, these components of the ATAC intervention aim to promote acute HIV testing, and to minimize the potential burden of testing on the providers, while ensuring that patients are rapidly linked to care and prevention services. In a 3 year project, we will accomplish three Specific Aims: ¿ First, we will fully develop, refine and operationalize the ATAC intervention. As interventions will involve new activities that will affect health department operations and patient care, intervention protocols for these activities will be pilot tested and refined based on feedback from these key stakeholders. ¿ Second, we will conduct a pilot study of the full ATAC intervention among 25 ambulatory care providers in a large public hospital ambulatory care clinic over a 1 year period, and measure the change in the total number of acute HIV cases identified under the ATAC intervention versus prior to the intervention. ¿ Finally, we will conduct a mixed methods process evaluation, eliciting feedback from participants and key informants on the feasibility acceptability and perceived value of specific intervention components. At the completion of the project, we will assess whether the pilot results indicate feasibility of the intervention: in this case a final intervention will be manualied for use in a citywide ATAC HIV prevention program, the efficacy of which would be evaluated in a larger intervention trial. PUBLIC HEALTH RELEVANCE: The proposed research will explore expanding the identification of patients who have acute HIV infection, by diagnosing them when they present with 'flu-like' illnesses to clinics that provide drop-in medical care in San Francisco. We propose to pilot test a health services intervention strategy that will train, motivate and support provides in ambulatory care clinics to test high risk patients with flu-like illnesses for acute HIV infectin. Increasing the identification of acute HIV infections is an important goal of the National HIV Prevention Strategy, since these patients are especially infectious during their acute illness. This project will therefore provide important information to guide the local and national implementation of this Strategy.