Acute HIV infection detection in San Francisco and San Mateo
Creators: name: University Of California Office Of The President
Publisher: name: University of California Office of the President
publisherIdentifier: https://ror.org/00dmfq477
publisherIdentifierScheme: ROR
Year: 2024

description: Doctors and researchers are learning that the first few weeks after someone is infected with HIV are the time when that person is most likely to spread the virus to others. This means that efforts to prevent the spread of HIV need to find ways to reach people very close to the time of their infection. Standard HIV tests do not work very well to detect HIV in this time frame, since they can remain negative for two months or more after infection. New research has found, however, that special (HIV RNA) tests can be added to the standard (HIV antibody) tests to detect very new HIV infection early in this window of high contagiousness. So far, the use of these tests has been limited to demonstration projects at a few public HIV testing programs. To really work at stopping the spread of HIV, however, we believe that these special HIV tests must be made available as part of HIV testing everywhere—including, if possible, at all doctors’ offices. For this proposal, we will therefore create a collaboration between 1) the highly successful San Francisco public HIV RNA testing service and 2) doctors’ offices and clinics that can benefit from access to such testing. In so doing we hope to create a model program for HIV RNA testing that will enable public and private medical providers serving California’s diverse communities to find the greatest possible number of patients with very recent HIV infection. We propose a work plan in three phases. Working closely with providers, community representatives, University of California-San Francisco and San Francisco Department of Public Health (SFDPH), we will 1) create testing models designed to make special HIV testing and the management of those cases easy and routine; 2) start those models in the doctors’ offices and clinics selected; and 3) evaluate how those testing models find and manage very recently infected patients and 4) develop specific recommendations for expansion to more sites in California based on lessons learned. Over the first 3 months of the award, current SFDPH protocols will be adapted for centralized coordination of blood specimen processing and shipping from the different testing sites to be newly served by this expansion effort. Sites to be included in this project are the San Francisco General Hospital Medical Center; the SFDPH community-oriented primary care centers and affiliated clinics, including the Castro-Mission Heath Center, Tom Waddell Health Center and Mission Neighborhood Health Center; and the Edison Clinic in San Mateo County. As with the current SFDPH programs, appropriate information, disclosure, case management/confirmatory testing and partner services will occur. We anticipate that we will screen approximately 15,000 patients for very recent and chronic HIV infection over a 12-month period. An evaluation plan will include routinely collected information on negative and positive HIV test results, partner outcomes and some risk behavior information at each testing site. In order to increase the generalizability of our findings for California, we will conduct comparative analyses with data obtained from other public health jurisdictions in California. Finally, by incorporating both our own evaluations and possible collaborative analyses in a final summary report, we will develop recommendations for expansion of RNA testing in California.