Lessons learned about behavioral science and acute/early HIV infection. The NIMH Multisite Acute HIV Infection Study: V.

Center for AIDS Intervention Research (CAIR), Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, 53202, USA.
AIDS and Behavior (Impact Factor: 3.49). 07/2009; 13(6):1068-74. DOI: 10.1007/s10461-009-9579-1
Source: PubMed


Acute/early HIV infection is a period of heightened HIV transmission and a window of opportunity for intervention to prevent onward disease transmission. The NIMH Multisite Acute HIV Infection (AHI) Study was an exploratory initiative aimed at determining the feasibility of recruiting persons with AHI into research, assessing their psychosocial and behavioral characteristics, and examining short-term changes in these characteristics. This paper reports on lessons learned in the study, including: (1) the need to establish the cost-effectiveness of AHI testing; (2) challenges to identifying persons with AHI; (3) the need to increase awareness of acute-phase HIV transmission risks; (4) determining the goals of behavioral interventions following AHI diagnosis; and (5) the need for "rapid response" public health systems that can move quickly enough to intervene while persons are still in the AHI stage. There are untapped opportunities for behavioral and medical science collaborations in these areas that could reduce the incidence of HIV infection.

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    • "This is the first in a series of five papers in this issue of the journal (see Remien et al. 2009; Steward et al. 2009; Atkinson et al. 2009; Kelly et al. 2009) that describe results from the National Institute of Mental Health (NIMH) Multisite Acute HIV Infection Study, an exploratory study with the aims of determining the feasibility of detecting and recruiting individuals with AHI into research studies; better understanding the social and psychological context of recent HIV transmissions; and assessing sexual behavior, substance use, and the psychological state of individuals during the periods before and after diagnosis. This research provides formative results to inform development of effective prevention interventions for persons with acute/early HIV infection. "
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    ABSTRACT: Acute/early HIV infection plays a critical role in onward HIV transmission. Detection of HIV infections during this period provides an important early opportunity to offer interventions which may prevent further transmission. In six US cities, persons with acute/early HIV infection were identified using either HIV RNA testing of pooled sera from persons screened HIV antibody negative or through clinical referral of persons with acute or early infections. Fifty-one cases were identified and 34 (68%) were enrolled into the study; 28 (82%) were acute infections and 6 (18%) were early infections. Of those enrolled, 13 (38%) were identified through HIV pooled testing of 7,633 HIV antibody negative sera and 21 (62%) through referral. Both strategies identified cases that would have been missed under current HIV testing and counseling protocols. Efforts to identify newly infected persons should target specific populations and geographic areas based on knowledge of the local epidemiology of incident infections.
    AIDS and Behavior 12/2009; 13(6):1037-1045. DOI:10.1007/s10461-009-9580-8 · 3.49 Impact Factor
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    • "This is the third in a series of five papers (see also Atkinson et al. 2009; Kelly et al. 2009; Kerndt et al. 2009; Remien et al. 2009) that describe results from the National Institute of Mental Health Multisite Acute HIV Infection Study (see Kerndt et al. 2009, for the overall aims of the study). In the analyses presented here, we examine changes in sexual risk behaviors, seeking specifically to understand the degree to which such changes are a product of reductions in partners, reductions in sex acts, increases in condom use, and use of serosorting and seropositioning. "
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    ABSTRACT: Risk reductions behaviors are especially important during acute/early HIV infection, a period of high transmission risk. We examined how sexual behaviors changed following diagnosis of acute/early HIV infection. Twenty-eight individuals completed structured surveys and in-depth interviews shortly after learning of their infection and 2 months later. Quantitative analyses revealed significant changes after diagnosis, including reductions in total partners and decreases in the proportion of unprotected sex acts occurring with uninfected partners (serosorting). Qualitative findings indicated that these changes were motivated by concerns about infecting others. However, participants were less successful at increasing the frequency with which they used condoms. These results suggest that the initial diagnosis with HIV may constitute an important component of interventions to promote risk reduction during the acute/early stages of the disease.
    AIDS and Behavior 07/2009; 13(6):1054-60. DOI:10.1007/s10461-009-9582-6 · 3.49 Impact Factor
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    ABSTRACT: Acute HIV infection (AHI) is the earliest stage of HIV disease, when plasma HIV viremia, but not HIV antibodies, can be detected. Acute HIV infection often presents as a nonspecific viral syndrome. However, its diagnosis, which enables linkage to early medical care and limits further HIV transmission, is seldom made. We describe the experience of Yale's Center for Interdisciplinary Research on AIDS with AHI diagnosis in Connecticut, as a participating center in the National Institute of Mental Health Multisite AHI Study. We sought to identify AHI cases by clinical referrals and by screening for AHI at two substance abuse care facilities and an STD clinic. We identified one case by referral and one through screening of 590 persons. Screening for AHI is feasible and probably cost effective. Primary care providers should include AHI in the differential diagnosis when patients present with a nonspecific viral syndrome.
    Connecticut medicine 06/2009; 73(6):325-31.
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