Acute HIV infection dection in San Francisco and San Mateo

Jeffrey Klausner, San Francisco Department of Public Health
Basic-Applied Clinical

Increasing evidence suggests that acute HIV infection is a main driver of the epidemic, emphasizing the potential impact of early interventions at both patient and population level. Although recent studies have demonstrated the value of acute case detection, those initiatives have so far been limited to publicly funded HIV testing sites. To be truly effective at reducing HIV transmission, acute HIV-centered prevention strategies must move beyond such sites, to doctor's offices, clinics and medical centers where the majority of HIV testing occurs. By extending the highly successful public health model for acute HIV screening currently used at the San Francisco STD clinic, into primary care, urgent care and emergency department settings, this proposal intends to include a more diverse Bay Area population and establish methods suitable for further dissemination statewide.

Working closely with providers, community representatives, University of California-San Francisco (UCSF) and San Francisco Department of Public Health (SFDPH), we will 1) develop and implement integrated models designed to facilitate the accurate screening, results notification, counseling, and both clinical and public health case management of cases of acute HIV infection in our expansion sites; and 2) evaluate the feasibility, acceptability and impact of those acute HIV screening models, and 3) develop specific recommendations for expansion to additional sites with California based on lessons learned.

Over the first 3 months of the award, current SFDPH protocols for acute HIV screening will be adapted to the new expanded testing. Sites to be included are the San Francisco General Hospital Medical Center and affiliated clinics; the San Francisco Department of Public Health 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, appropriate information, disclosure, case management/confirmatory testing and partner services will be implemented. HIV RNA laboratory testing will continue to take place at the SFDPH Laboratory which has been doing such pooled screening since 2003. .

A research plan will be developed to evaluate already routinely collected information on negative and positive HIV test results, notification/partner outcomes and some risk behavior information at each testing site. Outcomes to be measured during the project include the number of patients tested, number of (true/false) positives, patient demographics, risk behaviors, current STDs, CD4+ T-cell counts, time-to-first CD4+ T-cell count, time-to-first HIV care visit, number and characteristics of the partners, adverse events, and acceptability/perceptions of program procedures. To assess the performance and potential impact of proposed models, we will screen about 15,000 patients for acute and chronic HIV infection over a 12-month period.

To increase the generalizability of our findings for California, we will conduct comparative analyses with data obtained from other public health jurisdictions in California (including the San Diego Department of Health). 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.