The STOP Study

急性艾滋病毒感染（AHI）是从艾滋病毒传播到抗体产生的一段时间，在此期间，不受阻碍的病毒复制导致血液和生殖器分泌物中的病毒载量极高。因此，通过无保护性交传播AHI的概率非常高；据估计，美国43%的新感染艾滋病毒是由AHI患者传播的。这具有重要的公共卫生意义，因为AHI患者可能继续从事高风险行为，导致最近感染艾滋病毒，特别是如果他们不知道自己被感染。因此，识别患有AHI的个体为避免大量后续传播事件提供了关键机会。虽然互联网已被清楚地证明是男同性恋者的高风险环境，这个群体占美国新感染艾滋病毒的50%以上，占北卡罗来纳州（NC） AHI病例的56%，但它作为传统伴侣通知的补充尚未得到充分探索。目前，通过对血清阴性患者进行HIV RNA合并检测来检测AHI的NC策略是有效的，但由于第三代血清EIA检测和HIV RNA合并策略的技术问题，该策略的缺点是成本高，并且从检测到确诊AHI的时间较长。为了克服这样的后勤和成本挑战以及从筛查到AHI诊断的延迟，本横断面研究将实施一种新的第四代EIA检测，该检测同时检测HIV-1/2抗体和p24抗原，从而减少血清转化窗口期并检测血清转化前p24抗原的存在。该研究将比较第四代EIA与其他HIV诊断方法诊断AHI的性能、成本效益和速度。研究数据将用于评估使用新的检测策略可能节省的成本和早期检测AHI的能力，这对在公共资助的HIV检测站点和二级预防中使用新的HIV抗体分析具有重要意义。包括我们自己的研究在内的几项研究都表明，熟悉和接触互联网为男同性恋者提供了结识性伴侣和从事高风险行为的机会。缺乏合作伙伴信息已被证明限制了通过传统手段完全执行合作伙伴通知的能力。本研究将结合一种新的互联网干预措施，加强伴侣追踪，并确定其在增加急性感染患者伴侣的通知、筛查和治疗方面的可行性、成本效益和收益。使用互联网技术通知伴侣还将包括与艾滋病毒AHI检测站点信息的实时联系、与AHI相关的症状以及转介到艾滋病毒和性病护理。

DESCRIPTION (provided by applicant): Project Summary Acute HIV infection (AHI) is the period from HIV transmission until antibodies develop and during which unimpeded viral replication results in extremely high viral loads in the blood and genital secretions. Accordingly, the probability of transmission during unprotected intercourse with AHI is very high; an estimated 43% of all new HIV infections in the US are transmitted by persons with AHI. This has critical public health implications since individuals with AHI are likely to continue engaging in high-risk behaviors that led to recent HIV acquisition, particularly if they do not know they are infected. As such, identifying individuals with AHI provides a critical opportunity to avert a significant number of onward transmission events. While the Internet has clearly been shown to be a high risk environment for MSM, a group that accounts for over 50% of new HIV infections in the US and 56% of AHI cases in North Carolina (NC), its use as a complement to traditional partner notification has not been fully explored. The current NC strategy to detect AHI using pooled HIV RNA testing on seronegatives is effective, but the disadvantages of this strategy include high cost and a prolonged time from testing to confirmed AHI diagnosis due to technical aspects of 3rd generation serum EIA testing and the HIV RNA pooling strategy. To overcome such logistical and cost challenges and the delay from screening to AHI diagnosis, this cross-sectional study will implement a novel a 4th generation EIA assay, which simultaneously detects HIV-1/2 antibodies and p24 antigen, thereby decreasing the seroconversion window period and detecting the pre-seroconversion presence of p24 antigen. The study will compare the performance, cost-effectiveness, and rapidity of a 4th generation EIA to other HIV diagnostic assays to diagnose AHI. Study data will be used to evaluate the potential cost savings and ability to detect AHI earlier with the use of new testing strategies, with critical implications for the use of newer HIV antibody assays in publicly funded HIV testing sites and secondary prevention. Several studies, including our own, indicate that familiarity with and access to the Internet provides opportunities for MSM to meet sex partners and engage in high risk behaviors. The lack of partner information has been shown to limit the ability to completely perform partner notification by traditional means. This study will incorporate enhanced partner tracing with a novel Internet intervention and determine its feasibility, cost-effectiveness and yield in increasing the notification, screening and treatment of partners of acutely infected patients. The use of internet technologies for partner notification will also include real-time linkage to information on HIV testing sites for AHI, symptoms associated with AHI and referral to HIV and STD care.