Acute Detection and Early Prevention Trial
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: Early detection of HIV infection is important for the health of the individual and for the opportunity to prevent the spread of HIV to others. Very early HIV infection (acute HIV) is a significant public health threat because at that stage of infection, most individuals are unaware of their HIV status, yet are highly infectious. In our previous research, over a third of new infections originated from source partners in the acute or early stage of HIV infection. Standard Rapid HIV testing, which detects antibodies to HIV, cannot diagnose individuals who have acute HIV infection, but the virus itself can be detected by testing for the nucleic acids in HIV. This nucleic acid testing (NAT) can identify people with acute HIV infection and is currently used to protect the blood supply used for transfusions. In North Carolina, NAT screening was shown to be cost effective for identifying people with acute HIV at public health HIV testing sites. The County of San Diego and the University of California San Diego (UCSD) started a pilot program of NAT screening in November 2006 at one County HIV testing site. We propose to expand our current program into five County HIV testing sites. The HIV epidemic in San Diego is typical of the rest of California, so it is an ideal place to demonstrate the feasibility of implementing more widespread NAT screening. The County of San Diego has the third most AIDS cases in California, and the County public health department is similar in structure to others in California. In San Diego, men who have sex with men outnumber other HIV risk groups, which is also similar to the rest of California. Almost half of new HIV cases in San Diego are in the Hispanic population, a trend seen throughout Southern California. Mr. Cunningham from the County of San Diego Public Health Services will collaborate with Dr. Little from UCSD on the proposed expanded NAT screening program. The County will provide the infrastructure and the education, consent, and enrollment of clients needed for 3,600 HIV NAT screens over the fifteen-month study period. UCSD will be responsible for human subject protections, development of NAT program processes, and training of test counselors. UCSD will also coordinate the transport of blood samples to the American Red Cross laboratory for NAT and the delivery of results to the clients tested. Trained UCSD and County personnel will directly contact clients found to have acute HIV infection. Clients whose NAT shows no infection can receive their results through secure voice mail and Internet systems. The NAT assay used in this program also tests for hepatitis C virus (HCV), and we will refer those found to have HCV infection to appropriate care. We also offer clients who have a positive Rapid HIV test an additional test that can show if their infection is still in an early stage. Since people who have either acute or early HIV infection are an important source of other new infections, we specifically target these groups for partner referral services. Our detailed evaluation of our program, including NAT process requirements and costs, will demonstrate the feasibility of NAT in California public health sites. We have a collaborative agreement with San Francisco-based researchers to share our data to achieve a more robust and representative evaluation. The NAT materials and procedures developed in San Diego will be available to help implement NAT screening throughout California in the future.