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

描述(由申请人提供)：拟议的研究将解决旧金山门诊护理医疗环境中急性艾滋病毒感染的识别问题。许多艾滋病毒急性感染者因急性逆转录病毒综合症的症状而寻求医疗护理，因为这些症状具有很强的传染性。在医疗环境中确诊的急性艾滋病毒感染将有助于及早发现艾滋病毒病例和减少艾滋病毒传播的机会。然而，现实世界中在门诊护理医疗环境中发现急性病例的潜力尚不清楚。增加症状驱动的急性艾滋病毒诊断检测的战略也没有在这一领域进行测试。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，该干预措施专门用于增加门诊护理人员对急性艾滋病毒感染的诊断。门诊护理中的艾滋病毒急性检测(ATAC)干预措施解决了在繁忙环境下进行艾滋病毒急性检测存在的障碍，方法是：通过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；引入快速和简单的急性艾滋病毒诊断算法；与患者合作，提高检测的接受度；以及使用新的联动支持干预，向患者披露阳性结果，并协调联动和 对急性病例的随访。ATAC干预措施的这些组成部分旨在促进急性艾滋病毒检测，并将检测对提供者的潜在负担降至最低，同时确保患者迅速获得护理和预防服务。在一个为期3年的项目中，我们将实现三个具体目标：首先，我们将全面开发、完善和运作ATAC干预措施。因为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，对这些活动的操作和患者护理、干预方案进行试点测试和改进。第二，我们会在一间大型公立医院日间护理诊所的25名门诊医护人员中，进行为期一年的全面抗炎治疗试验研究，并量度在抗炎措施下发现的急性爱滋病个案总数与干预前比较的变化。最后，我们将进行混合方法过程评估，征求参与者和关键信息提供者对特定干预组件的可行性、可接受性和感知价值的反馈。在项目完成时，我们将评估试点结果是否表明干预措施的可行性：在这种情况下，最终干预措施将被手动用于全市ATAC艾滋病毒预防计划，其效果将在更大的干预试验中进行评估。

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.