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Sustaining an Effective Response to Acute HIV Infection Among Gay Men BC Gay Men’s Health Summit – November 3, 2011 Mark G...
Contributors <ul><li>Michael Kwag </li></ul><ul><li>Malcolm Steinberg </li></ul><ul><li>Darrel Cook </li></ul><ul><li>Mel ...
CIHR Acute HIV Study Team and Collaborators HIV Emerging Team National HIV and Retroviral  Laboratories James Brooks Natio...
Presentation Outline <ul><li>Background (Acute HIV, Window Periods) </li></ul><ul><li>Overview of CIHR study & social mark...
Why is acute HIV important? <ul><li>HIV prevention </li></ul><ul><ul><li>High viral load = high probability of transmissio...
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! <ul><li>Window periods </li></ul><ul><li>HIV test options </li></ul><ul><li>Acute HIV ...
December 2009 - Feb 2010
August 2011 to present
Relevant CIHR study objectives <ul><li>To diagnose acutely infected gay, bisexual and other MSM using innovative laborator...
Methods – HIV positive cohort <ul><li>Mixed-methods (quant/qual), longitudinal cohort study </li></ul><ul><li>Recruitment:...
For this analysis <ul><li>Used PHSA laboratory testing data to describe the impact of introducing pooled NAAT testing at t...
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-poolin...
Factors explaining increase? <ul><li>Introduction of pooled NAAT testing </li></ul><ul><li>Impact of social marketing camp...
Conclusion? <ul><li>Introducing Pooled NAAT testing is effective!  </li></ul><ul><ul><li>Diagnoses made that would otherwi...
Acute HIV “Buzz” <ul><li>Potential benefit recognized from outset by community and public health partners </li></ul><ul><l...
Option1 : Sustain or expand pooled NAAT… <ul><li>Problem:  $$$ </li></ul><ul><li>Not cost-effective to implement province-...
…  and/or Option 2: 4 th  generation screening tests 2 - 3 weeks
…  and/or Option 2: 4 th  generation screening tests <ul><li>Implemented in Quebec </li></ul><ul><li>Cheaper test, could i...
What next? <ul><li>Merits to both options (our preference: both) </li></ul><ul><li>Preparing appropriate policy documents ...
What do you think? <ul><li>Contact Info:  </li></ul><ul><ul><li>Mark Gilbert, Co-Principal Investigator </li></ul></ul><ul...
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05 gilbert marksummit 2011

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05 gilbert marksummit 2011

  1. 1. 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
  2. 2. Contributors <ul><li>Michael Kwag </li></ul><ul><li>Malcolm Steinberg </li></ul><ul><li>Darrel Cook </li></ul><ul><li>Mel Krajden </li></ul>
  3. 3. 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
  4. 4. Presentation Outline <ul><li>Background (Acute HIV, Window Periods) </li></ul><ul><li>Overview of CIHR study & social marketing campaigns </li></ul><ul><li>Description of the impact of introducing testing for acute HIV infection (pooled NAAT testing) </li></ul><ul><li>Review of current policy options & next steps </li></ul>
  5. 5. Why is acute HIV important? <ul><li>HIV prevention </li></ul><ul><ul><li>High viral load = high probability of transmission </li></ul></ul><ul><ul><li>Earlier diagnosis & potential for behaviour change </li></ul></ul><ul><ul><li>Active sexual networks </li></ul></ul>(Brenner JID 2007; Fraser CROI 2006; Galvin Nature Rev Micro 2004; Hayes JID 2005)
  6. 6. Appearance of markers of HIV infection (BCCDC 2010)
  7. 7. Window period – “standard testing” 3 - 4 weeks
  8. 8. Window period – pooled NAAT 10-12 days
  9. 10. Not easy to understand, or explain! <ul><li>Window periods </li></ul><ul><li>HIV test options </li></ul><ul><li>Acute HIV and why important </li></ul><ul><li>Ramifications? </li></ul><ul><ul><li>Delays in testing (wait 3-6 months to test) </li></ul></ul><ul><ul><li>Not taking advantage of current tests </li></ul></ul>
  10. 11. December 2009 - Feb 2010
  11. 12. August 2011 to present
  12. 13. Relevant CIHR study objectives <ul><li>To diagnose acutely infected gay, bisexual and other MSM using innovative laboratory testing methods (NAAT and 4th generation EIA tests) </li></ul><ul><li>To promote HIV testing as a first response to risk events through community based social marketing initiatives </li></ul>
  13. 14. Methods – HIV positive cohort <ul><li>Mixed-methods (quant/qual), longitudinal cohort study </li></ul><ul><li>Recruitment: April 2009-December 2012 </li></ul><ul><li>Eligibility: </li></ul><ul><ul><li>Gay or MSM, 19 or older </li></ul></ul><ul><ul><li>Acute or recent HIV diagnosis </li></ul></ul><ul><li>Study sites: 7 clinics in Vancouver </li></ul><ul><ul><li>Gay men as clients; history of frequent HIV diagnosis in gay men </li></ul></ul><ul><li>Intervention: </li></ul><ul><ul><li>Enhanced HIV testing protocol (NAAT) </li></ul></ul><ul><ul><li>Enhanced support: Professional and Peer-based counseling </li></ul></ul><ul><li>Current participants: 23 (9 acute; 14 recent) </li></ul>
  14. 15. For this analysis <ul><li>Used PHSA laboratory testing data to describe the impact of introducing pooled NAAT testing at the CIHR study sites </li></ul><ul><li>Compared pre- and post-pooling periods </li></ul>
  15. 16. New positive HIV tests, Men 19+ years CIHR study sites
  16. 17. 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
  17. 18. Factors explaining increase? <ul><li>Introduction of pooled NAAT testing </li></ul><ul><li>Impact of social marketing campaigns </li></ul><ul><li>Increased testing volume </li></ul><ul><li>Other? </li></ul>
  18. 19. Conclusion? <ul><li>Introducing Pooled NAAT testing is effective! </li></ul><ul><ul><li>Diagnoses made that would otherwise be missed </li></ul></ul><ul><ul><li>Greater opportunities for prevention of HIV transmission </li></ul></ul><ul><li>Valuable prevention tool for gay men </li></ul><ul><li>What now? The study ends December 2012… </li></ul>
  19. 20. Acute HIV “Buzz” <ul><li>Potential benefit recognized from outset by community and public health partners </li></ul><ul><li>These results have been discussed within STOP </li></ul><ul><li>Considered a success </li></ul>
  20. 21. Option1 : Sustain or expand pooled NAAT… <ul><li>Problem: $$$ </li></ul><ul><li>Not cost-effective to implement province-wide </li></ul><ul><li>Looking into: </li></ul><ul><ul><li>Sustaining beyond 2012 at the study sites </li></ul></ul><ul><ul><li>Expansion to select HIV testing sites with high diagnosis rates </li></ul></ul>
  21. 22. … and/or Option 2: 4 th generation screening tests 2 - 3 weeks
  22. 23. … and/or Option 2: 4 th generation screening tests <ul><li>Implemented in Quebec </li></ul><ul><li>Cheaper test, could implement across province </li></ul><ul><li>Reduces window period of “standard” test, would detect more acute HIV infections than 3 rd gen EIA </li></ul><ul><li>However, would miss many acute HIV infections as well </li></ul><ul><ul><li>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. </li></ul></ul><ul><li>Gay men are more likely to test during the acute phase of HIV infection </li></ul>
  23. 24. What next? <ul><li>Merits to both options (our preference: both) </li></ul><ul><li>Preparing appropriate policy documents & business case for decision-makers </li></ul><ul><li>Conducting further head-to-head comparison of pooled NAAT and 4 th gen screening tests, to better understand impact (2012) </li></ul><ul><li>Publication of findings & knowledge translation </li></ul>
  24. 25. What do you think? <ul><li>Contact Info: </li></ul><ul><ul><li>Mark Gilbert, Co-Principal Investigator </li></ul></ul><ul><ul><ul><li>[email_address] </li></ul></ul></ul><ul><ul><li>Michael Kwag, Research Project Manager </li></ul></ul><ul><ul><ul><li>[email_address] </li></ul></ul></ul><ul><ul><ul><li>778-886-7781 </li></ul></ul></ul>

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