PS06-002 Rap Test Algorithm in Non-Trad Test Stes to Improve Linkage to Care

描述（申请人提供）：本项目的具体目标是：a）为利用诊断快速检测算法制定书面协议，B）确定实施的最佳实践，c）评估这种算法的优点和缺点，d）验证诊断快速HIV检测算法的使用，（e）评估根据与现行做法不同的算法获得初步阳性结果的未感染艾滋病毒的客户的比例，（f）评估根据与现行做法不同的算法获得经确认的艾滋病毒阳性检测结果披露的艾滋病毒感染者的比例，（g）评估感染艾滋病毒的客户中因通过与现行做法不同的算法进行诊断而被转诊并接受初级医疗护理的比例，（h）评估使用诊断算法进行艾滋病毒检测的费用。 该项目的广泛和长期目标符合各机构的任务，即：（a）增加艾滋病毒感染者的人数，使他们了解自己的状况，并尽早接受医疗护理和预防服务，以防止传染给他人，B）减轻艾滋病毒快速检测方案的实施和维持对表演场地工作人员的负担，以及c）提高为高风险和难以接触到的客户提供的艾滋病毒检测服务的效率和质量。 七个干预站点将根据以下算法提供快速HIV检测：将运行FDA批准的CLIA豁免快速检测。如果测试是反应性的，将运行第二个CLIA豁免的快速测试。如果该测试也是反应性的，客户将被诊断为艾滋病毒阳性，并与医疗护理。将抽取血液，并将安排在一周后预约，以公布确认测试的结果。如果第二次快速检测无反应，则将进行第三次快速检测以确定诊断，并抽取血液进行确认。13个比较地点将根据现行的实践标准提供快速艾滋病毒检测：进行CLIA豁免的快速艾滋病毒检测，如果初步呈阳性，则抽血确认。在一周后的确认披露预约中，客户被诊断出感染了艾滋病毒，并与医疗护理有关。将向干预地点和比较地点提供援助，以加强跟踪与所有艾滋病毒检测呈阳性者的医疗保健和其他必要支助服务的联系。 这项研究与公共卫生有关，因为及早发现艾滋病毒抗体阳性者并将其与医疗保健联系起来，可以降低传播率和提供后期诊断医疗保健的负担。

DESCRIPTION (provided by applicant): The specific aims of this project are to: a) develop written protocols for utilizing a diagnostic rapid testing algorithm, b) identify best practices for implementation, c) evaluate the advantages and disadvantages of such an algorithm, d) to validate the use of a diagnostic rapid HIV testing algorithm, e) assess the proportion of non-HIV-infected clients who receive a preliminary positive result according to the algorithm as opposed to current practice, f) assess the proportion of HIV-infected clients who receive disclosure of a confirmed HIV positive test result according to the algorithm as opposed to current practice, g) assess the proportion of HIV-infected clients who are referred to and receive primary medical care as a result of diagnosis through the algorithm as opposed to current practice, h) assess the cost of HIV testing with a diagnostic algorithm. The broad, long-term objectives of this project are in line with the agencies' missions to: a) increase the number of HIV-infected individuals who learn their status and enter into early medical care and prevention services to prevent transmission to others, b) reduce the burden of rapid HIV testing program implementation and maintenance on the staff of performance sites, and c) improve the efficiency and quality of HIV testing services available for high-risk and hard to reach clientele. Seven intervention sites will be providing rapid HIV testing according to the following algorithm: an FDA approved CLIA-waived rapid test will be run. If the test is reactive, a second CLIA-waived rapid test will be run. If that test is also reactive, the client will be diagnosed as HIV-positive and linked to medical care. Blood will be drawn and an appointment will be scheduled for one week later to disclose the results of confirmatory testing. If the second rapid test is non-reactive, then a third rapid test will be run to determine diagnosis and blood will be drawn for confirmation. Thirteen comparison sites will be providing rapid HIV testing according to the current standard of practice: a CLIA-waived rapid HIV test is run, and if preliminary positive, blood is drawn for confirmation. At the confirmatory disclosure appointment one week later, the client is diagnosed with HIV and linked to medical care. Assistance will be provided to both intervention and comparison sites to enhance the tracking of linkages to medical care and other necessary support services for all individuals testing HIV-positive. This research is relevant to public health because early identification of HIV-positive people and linkage to medical care reduces the rate of transmission and the burden of providing late-diagnosis medical care.