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  • Sources: Brenner B.G. et al. (2007). High rates of forward transmission events after acute/early HIV-1 infection. Journal of Infectious Diseases, 195(7):951–9. Fraser C, et al. (2006) Quantifying the impact of primary infection on HIV transmission and control. Program and abstracts of the 13th Conference on Retroviruses and Opportunistic Infections; February5-8, 2006; Denver, Colorado. Abstract 162. Galvin SR, Cohen MS. The Role of Sexually Transmitted Diseases in HIV Transmission Nature Reviews Microbiology 2004 Hayes RJ, White RG (2005). Amplified HIV transmission during early-stage infection. JID; 193(4):604–5
  • Can still diagnose acute HIV infection using our standard testing protocol Individual NAAT window period
  • Background / Objectives Collaboration between HIM and CIHR Team to produce knowledge diffusion campaign to increase awareness of new HIV testing technologies (Point of Care, NAAT) Opening of HIM Sexual Health Centre Key Message: New HIV testing options (“rapid” and “early” HIV testing) mean less waiting (for results, to get tested) Implementation Creative development: Creative brief (co-developed by HIM and CIHR Team), focus groups (November 2009) Campaign live from December 2009-February 2010 (10 weeks) Project Outputs/Media: Website, web banners, email blasts, HIM condom packs, posters, business cards, newspapers
  • Brings together sexual and transmission dynamics of HIV into one message Objectives Goal: To increase HIV testing frequency among gay men who have UAI with a partner whose HIV status is different or unknown (risky sex) Target Audience: Gay men who have risky sex and who believe they are HIV-negative Gay men who have risky sex and are under 30 Gay men who have risky sex and test for HIV less than twice per year
  • I will update this slide with the most current data. Indicate WRUW4 campaign: Dec 2009-Feb 2010; Hottest at the Start Aug 2011-
  • Email from Mel K (5 Oct 2011): Below some very interesting data compiled by Darrel from the CIHR pooled NAT study outlining the impact of the study on the detection rates of acute, recent and established HIV.  Of the Acute HIV cases approximately 30% were negative by 4th generation anti-HIV and 40% were negative by 3rd generation anti-HIV. While the overall numbers of new cases declined over the study period the number of acute HIV cases indentified more than doubled. Mel Note from Darrel: For the 10 AHI cases missed by 3rd gen:      Abbott AxSYM 4th gen: 3 positive; 4 negative ; 3 not tested      Siemens 4th gen: 3 positive (the same ones as were positive on Abbott), 6 negative , 1 not tested Email from Malcolm: The data also suggest that if BCCDC goes with the Siemens 4th gen combo, we may well miss a significant number of acutes. The Abbott test does better but still misses some cases. These data make our back-to-back comparison of pooled NAAT and 4th generation testing all the more important.
  • Can still diagnose acute HIV infection using 3 rd gen EIA
  • Can still diagnose acute HIV infection using 3 rd gen EIA

05 gilbert marksummit 2011 05 gilbert marksummit 2011 Presentation Transcript

  • Sustaining an Effective Response to Acute HIV Infection Among Gay Men BC Gay Men’s Health Summit – November 3, 2011 Mark Gilbert BC Centre for Disease Control
  • Contributors
    • Michael Kwag
    • Malcolm Steinberg
    • Darrel Cook
    • Mel Krajden
  • CIHR Acute HIV Study Team and Collaborators HIV Emerging Team National HIV and Retroviral Laboratories James Brooks National Lab for HIV Genetics Paul Sandstrom Terry Trussler, Rick Marchand, Olivier Ferlatte North Carolina HIV/STD Prevention Peter Leone Josephine McIntosh Mathematics Department Daniel Coombs STI/HIV Prevention & Control Michael Rekart , Mark Gilbert , Malcolm Steinberg, Michael Kwag, Bill Coleman, Gina Ogilvie, Melanie Achen, Glenn Doupe, Daphne Spencer, Cory Genereaux, Daniel Grace, Sarah Chown, Robin Parry Mathematical Modeling Babak Pourbohloul , Jennifer Lindquist, Flavia Moser Laboratory Services Mel Krajden, Darrel Cook, Wendy Mei Epidemiology David Patrick Benedikt Fisher Elgin Lim Jody Jollimore, Hans Bosgoed Wayne Robert Captain Snowden Richard Rothenberg Recruitment Sites 12 th Avenue, Bute Street, Spectrum Health, 3 Bridges, Dr Richard Taylor, Cook Street, HIM SHC
  • Presentation Outline
    • Background (Acute HIV, Window Periods)
    • Overview of CIHR study & social marketing campaigns
    • Description of the impact of introducing testing for acute HIV infection (pooled NAAT testing)
    • Review of current policy options & next steps
  • Why is acute HIV important?
    • HIV prevention
      • High viral load = high probability of transmission
      • Earlier diagnosis & potential for behaviour change
      • Active sexual networks
    (Brenner JID 2007; Fraser CROI 2006; Galvin Nature Rev Micro 2004; Hayes JID 2005)
  • Appearance of markers of HIV infection (BCCDC 2010)
  • Window period – “standard testing” 3 - 4 weeks
  • Window period – pooled NAAT 10-12 days
  •  
  • Not easy to understand, or explain!
    • Window periods
    • HIV test options
    • Acute HIV and why important
    • Ramifications?
      • Delays in testing (wait 3-6 months to test)
      • Not taking advantage of current tests
  • December 2009 - Feb 2010
  • August 2011 to present
  • Relevant CIHR study objectives
    • To diagnose acutely infected gay, bisexual and other MSM using innovative laboratory testing methods (NAAT and 4th generation EIA tests)
    • To promote HIV testing as a first response to risk events through community based social marketing initiatives
  • Methods – HIV positive cohort
    • Mixed-methods (quant/qual), longitudinal cohort study
    • Recruitment: April 2009-December 2012
    • Eligibility:
      • Gay or MSM, 19 or older
      • Acute or recent HIV diagnosis
    • Study sites: 7 clinics in Vancouver
      • Gay men as clients; history of frequent HIV diagnosis in gay men
    • Intervention:
      • Enhanced HIV testing protocol (NAAT)
      • Enhanced support: Professional and Peer-based counseling
    • Current participants: 23 (9 acute; 14 recent)
  • For this analysis
    • Used PHSA laboratory testing data to describe the impact of introducing pooled NAAT testing at the CIHR study sites
    • Compared pre- and post-pooling periods
  • New positive HIV tests, Men 19+ years CIHR study sites
  • Summary of HIV test results from AHI CIHR project sites (Q1 2007 – Q2 2011) For the acute HIV cases identified post-pooling, 14 (41%) would have been missed if only the standard HIV test algorithm had been used. * Negative Point of Care tests not included. **HIM clinic added Sept 2010 Pre-Pooling (Q1 2007 – Q4 2008) Post-Pooling** (Q1 2009 – Q2 2011) % Change Test Volume* (specimens) 14,178 ( ~525 per month) 16,075 ( ~600 per month) 13% increase Test Volume* (individuals) 10,284 11,056 8% increase All New positive HIV Cases 173 155 10% decrease Acute HIV Cases 15 34 127% increase Recent HIV Cases 36 40 11% increase
  • Factors explaining increase?
    • Introduction of pooled NAAT testing
    • Impact of social marketing campaigns
    • Increased testing volume
    • Other?
  • Conclusion?
    • Introducing Pooled NAAT testing is effective!
      • Diagnoses made that would otherwise be missed
      • Greater opportunities for prevention of HIV transmission
    • Valuable prevention tool for gay men
    • What now? The study ends December 2012…
  • Acute HIV “Buzz”
    • Potential benefit recognized from outset by community and public health partners
    • These results have been discussed within STOP
    • Considered a success
  • Option1 : Sustain or expand pooled NAAT…
    • Problem: $$$
    • Not cost-effective to implement province-wide
    • Looking into:
      • Sustaining beyond 2012 at the study sites
      • Expansion to select HIV testing sites with high diagnosis rates
  • … and/or Option 2: 4 th generation screening tests 2 - 3 weeks
  • … and/or Option 2: 4 th generation screening tests
    • Implemented in Quebec
    • Cheaper test, could implement across province
    • Reduces window period of “standard” test, would detect more acute HIV infections than 3 rd gen EIA
    • However, would miss many acute HIV infections as well
      • We looked to see how well two types of 4 th gen EIA tests did at detecting HIV in the 14 men with acute HIV infection diagnosed through pooled NAAT: approximately 40-70% were missed.
    • Gay men are more likely to test during the acute phase of HIV infection
  • What next?
    • Merits to both options (our preference: both)
    • Preparing appropriate policy documents & business case for decision-makers
    • Conducting further head-to-head comparison of pooled NAAT and 4 th gen screening tests, to better understand impact (2012)
    • Publication of findings & knowledge translation
  • What do you think?
    • Contact Info:
      • Mark Gilbert, Co-Principal Investigator
        • [email_address]
      • Michael Kwag, Research Project Manager
        • [email_address]
        • 778-886-7781