The Efficacy and Impact of Routine HIV and TB Testing in Durban, South Africa

南非目前感染艾滋病毒的公民比世界上任何其他国家都多。身份识别 艾滋病毒感染者和结核病合并感染的快速检测对于改善获得 治疗，减少发病率，控制疫情的传播。尽管推广了免费 政府的自愿咨询和检测(VCT)网站以及几乎普遍提供的抗逆转录病毒药物 治疗，只有五分之一的南非人知道VCT地点进行了测试。应聘者试图评估 假设常规的艾滋病毒检测将增加检测吸收，并与麦考德医院的护理联系起来， 南非德班的一个城市中心，艾滋病毒感染率最高。四个相互关联的 提出了具体的目标：1)评估新建立的门诊艾滋病毒常规检测计划 部门(门诊部)检查患者接受程度、艾滋病毒流行率和阶段、与护理和 拒绝检测的原因，2)将常规艾滋病毒检测扩大到住院医疗服务，以检查 目标1中概述的参数并将它们与门诊设置中的参数进行比较，3)使用混合艾滋病毒 血浆RNA检测用于诊断急性HIV感染和估计紧急护理中的HIV发病率 住院环境，以及4)评估新入院患者普遍痰结核筛查的成效 被诊断出感染了艾滋病毒。候选人将获得流行病学和生物统计学基础，以实现这些目标 目标是通过哈佛公共卫生学院的课程工作和2名高年级学生的指导 临床调查人员具有较强的初级调查人员培养记录。这项工作实现了以下目标 美国国立卫生研究院艾滋病研究办公室，包括建立国际队列以进一步开展艾滋病毒预防研究， 评估干预措施对艾滋病毒相关结果的影响，并促进科学合作 美国科学家和他们在发展中国家的同行之间。常规的艾滋病毒检测有 有可能减少耻辱，提高对艾滋病毒检测的接受度，并增加人数 确认为艾滋病毒感染，并与护理有关。完成这项研究和教学方面的工作 该项目将为候选人提供从传染病研究员过渡到 国际艾滋病毒护理领域的独立临床调查员。

South Africa currently has more HIV infected citizens than any other country in the world. Identification of HIV-infected individuals and rapid detection of tuberculosis co-infection is paramount for improving access to treatment, decreasing morbidity, and controlling the spread of the epidemic. Despite promotion of free voluntary counseling and testing (VCT) sites by the government and the near universal offer of antiretroviral therapy, only 1 in 5 South Africans aware of VCT sites have been tested. The candidate seeks to evaluate the hypothesis that routine HIV testing will increase testing uptake and linkage to care at McCord Hospital, an urban center in Durban in the South African province with the highest HIV prevalence. Four interrelated specific aims are proposed: 1) To evaluate a newly established routine HIV testing program in the Outpatient Department (OPD) to examine level of patient acceptance, HIV prevalence and stage, linkage to care and reasons for testing refusal, 2) To expand routine HIV testing to the inpatient medical service to examine the parameters outlined in Aim 1 and compare them to those in the outpatient setting, 3) To use pooled HIV plasma RNA testing to diagnose acute HIV infection and estimate HIV incidence in the urgent care and inpatient settings, and 4) To evaluate the yield of universal sputum tuberculosis screening for patients newly diagnosed with HIV. The candidate will gain the epidemiologic and biostatistical foundation to achieve these aims through courseworkat the Harvard School of Public Health, and through the mentorship of 2 senior clinical investigators with strong records of cultivating junior investigators. This work fulfills goals stated by the NIH Office of AIDS Research, including creating international cohorts to further HIV prevention research, assessing the impact of interventions on HIV-related outcomes, and fostering scientific collaborations between American scientists and their counterparts in the developing world. Routine HIV testing has the potential to decrease stigma, increase acceptance of HIV testing, and increase the number of people identified with HIV infection and linked to care. Completion of the research and didactic aspects of this project will provide the candidate with the experience to make the transition from infectious disease fellow to independent clinical investigator in the field of international HIV care.