Acute HIV Infection (AHI) - the 10-week period after HIV-infection before antibodies are produced but when viral load is extremely high - plays a critical role in HIV transmission: as many as half of all new HIV infections may be attributable to transmission from an acutely infected person. Current policy and practice for routine HIV testing uses the HIV-antibody test, thus providing negative test results to acutely infected individuals precisely when they are at least 10 times as infectious as at later stages. Yet, those diagnosed with AHI often reduce their risk behaviors, thereby reducing rapid HIV transmission;and early treatment for AHI has short- and long-term individual clinical benefit. Test-and-Treat approaches to HIV prevention are based on expanded HIV-antibody testing combined with antiretroviral therapy to lower viral load. This strategy will be compromised if measures are not taken to improve detection of AHI. Yet, primary (non-HIV) care providers are often not aware of AHI or trained to screen for risk status and order diagnostic tests. Similarly, HIV test counselors are not trained to screen for AHI symptoms or to make warranted referrals for testing. Finally, primary healthcare clinics do not have the tools necessary to adopt structural changes necessary to optimize detection of AHI. To address this evolving public health challenge, this study proposes to develop and evaluate an innovative multi-level, multi-component, structural intervention (implemented at the level of the clinic) to promote routine screening and appropriate testing for AHI by medical care providers HIV-test counselors, and among their patients. The study will compare a "Basic Intervention" to an "Enhanced Intervention" to determine how intensive the intervention needs to be and what resources would be needed for widespread scale-up and dissemination. The study will be conducted in areas of high HIV incidence and prevalence in Bronx, NY by three collaborating partners: The HIV Center for Clinical and Behavioral Studies at the NY State Psychiatric Institute, the NY State Department of Health, AIDS Institute, and the NYC Department of Health and Mental Hygiene. There will also be involvement of local clinical and community stakeholders. Thus this innovative structural intervention has the potential to influence policy at the level of medical care clinics and in directives and guidance from national, state, and local Institutes and Departments of Health, which can in turn, have a large impact on HIV epidemiology, particularly in settings of high HIV incidence, domestically and internationally.
There is compelling evidence that acute HIV infection (AHI) plays a critical role in HIV transmission, because it is a period of time after infection when a person is highly infectious but before antibodies can be detected. As many as half of all new cases of HIV may be due to transmission during this period when the person does not know he/she is infected, and when the person can benefit from early treatment. Thus, increasing detection of AHI in communities of high HIV prevalence and incidence carries significant potential benefits for both the public and individual health.