When primary prevention for HIV infection is less than 100% effective, secondary prevention should incorporate undiagnosed HIV-positive individuals into counseling, testing, and treatment programs to reduce transmission to partners. Primary HIV infection (PHI) is the earliest period to detect HIV infection, and, if it accounts for the majority of transmission, increasing recognition of PHI could have the greatest impact on limiting the spread of the HIV epidemic.
In Aim #1, we propose to implement a public health campaign to teach the symptoms of PHI to high-risk individuals and to instruct them to seek testing at selected sites if they develop those symptoms. Surveys will ascertain whether the target population saw the campaign, learned the content, and whether that learning was sustained. We will compare, by Poisson and time series analysis, the number of individuals diagnosed with PHI by public health testing before and after the educational campaign. A cost-effectiveness analysis will assess the cost of the program per individual diagnosed with PHI. Finally, we hypothesize that an increase in referrals to the Seattle Primary Infection Clinic (PIC) will provide further evidence of the benefit of the educational campaign on recognition of PHI.
Aim #2, the PIC Partners Study, is part of a larger collaboration that has enrolled over 260 individuals with PHI into research studies over the last 12 years. Partners of new PIC enrollees will be screened for HIV infection and will complete a clinical and behavioral questionnaire. Transmitting (source) partners will be confirmed by viral sequencing, and a case-control study will be performed to quantify the odds of transmission associated with seminal plasma viremia in transmitting (case) versus non-transmitting (control) HIV-positive partners. These PHI projects will address novel issues related to recognition of incident infection, partnership factors contributing to transmission and acquisition, and program assessment. In the process, this award will provide learning opportunities and career development for the Principal Investigator in public health education methodology, cost-effectiveness and statistical analysis, and clinical research.

National Institute of Health (NIH)
National Institute of Allergy and Infectious Diseases (NIAID)
Mentored Patient-Oriented Research Career Development Award (K23)
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Study Section
Acquired Immunodeficiency Syndrome Research Review Committee (AIDS)
Program Officer
Burns, David N
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University of Washington
Internal Medicine/Medicine
Schools of Medicine
United States
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Stekler, Joanne D; Milne, Ross; Payant, Rachel et al. (2018) Transmission of HIV-1 drug resistance mutations within partner-pairs: A cross-sectional study of a primary HIV infection cohort. PLoS Med 15:e1002537
Stekler, Joanne D; Baldwin, Heather D; Louella, Michael W et al. (2013) ru2hot?: A public health education campaign for men who have sex with men to increase awareness of symptoms of acute HIV infection. Sex Transm Infect 89:409-14
Stekler, J D; Wellman, R; Holte, S et al. (2012) Are there benefits to starting antiretroviral therapy during primary HIV infection? Conclusions from the Seattle Primary Infection Cohort vary by control group. Int J STD AIDS 23:201-6
Shirreffs, Alexandra; Lee, David P; Henry, Jsani et al. (2012) Understanding barriers to routine HIV screening: knowledge, attitudes, and practices of healthcare providers in King County, Washington. PLoS One 7:e44417
Stekler, Joanne D; Ellis, Giovanina M; Carlsson, Jacquelyn et al. (2011) Prevalence and impact of minority variant drug resistance mutations in primary HIV-1 infection. PLoS One 6:e28952
Dombrowski, Julia C; Kerani, Roxanne P; Stekler, Joanne D et al. (2010) Antiretroviral therapy use among HIV-infected men who have sex with men attending a sexually transmitted diseases clinic. J Acquir Immune Defic Syndr 55:524-7
Stekler, Joanne D; Swenson, Paul D; Coombs, Robert W et al. (2009) HIV testing in a high-incidence population: is antibody testing alone good enough? Clin Infect Dis 49:444-53
Golden, Matthew R; Stekler, Joanne; Kent, James B et al. (2009) An evaluation of HIV partner counseling and referral services using new disposition codes. Sex Transm Dis 36:95-101
Stekler, Joanne D; Golden, Matthew R (2009) Learning from the missed opportunities for HIV testing. Sex Transm Infect 85:2-3
Golden, Matthew R; Stekler, Joanne; Hughes, James P et al. (2008) HIV serosorting in men who have sex with men: is it safe? J Acquir Immune Defic Syndr 49:212-8

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