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Presented by Michael Kwag, BC CDC, UBC, at the Gay Men’s Health Summit, November 9th, 2009 in Vancouver, BC.
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Extending Advanced Testing Services to Diagnose Early HIV Infection in Gay Men in Vancouver: Early Experiences
Presentation to Gay Men’s Health SummitNovember 10, 2009
Michael KwagResearch Project Manager
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Presentation Overview
• Background and Issues
• Study Description and Overview
• Lessons Learned
• Next Steps
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Awareness of Serostatus Among People with HIV and Estimates of
Transmission
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~55% of new infections
~45% of new infections
~25%unawareof infection
~75%awareof infection
PLWHA New infections each year
What Compartment is the Main Source of HIV Infection?
• Sources with Early Infection: high transmission probability, higher risk behaviors but short duration Eg. Koopman, JAIDS, 1997; 14(3):249-58.
• Sources with Chronic (asymptomatic) Infection: lower infectivity over longer duration but amenable to viral suppression, behavioral change following Dx Eg. Coutinho, B Math Biol, 2001; 63:1041-62.
• Sources with Late (symptomatic) Infection: intermediate infectivity with prolonged duration but have less risky behavior and less sexually active. Eg. Rapatski, JAIDS, 2005; 38(3):241-53.
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Susceptible
Risk Debut HIV infection HIV Dx HAART AIDS defining event
Infectious
Acute Chronic Late
Latent
Death
Source: Morris S. USCD Antiviral Research Center.
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0 10 20 40 50 60 70 80 90 100 36530
1st Gen. Ab Assay
3rd Gen. Ab Assay
p24 Ag Assay
4th Gen. Ag/Ab Assay
17 22 31
Window: 3-5 days ‘Sensitive’ Combo assays‘Sensitive’ Combo assays
HIV p24 Ag
Anti-HIV Ab
Adapted from: Fiebig et al AIDS, 17:1871-1879 (2003)
HIV RNA vsHIV Provirus DNA
7 Min 3 d to resolve the pool
Diagnosis of HIV Infection
The Nucleic Acid Amplification Screening Test
• HIV RNA test which involves the amplification and detection of viral RNA (as opposed to viral antigens or antibodies)
• Purpose is not to measure viral load but to detect HIV infection
• Main advantage is a shorter window period• Widely used in blood transfusion services• Cost effective use requires ‘pooling’
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Study Description
• CIHR 5-year grant housed at BCCDC to determine the feasibility and efficacy of using advanced testing technologies to identify and respond to AHI among gay men
• Study recruitment opened in April 2009 through implementation of laboratory algorithm for 4 strategic testing sites in Vancouver
• Multidisciplinary team: prevention, formative, and mathematical modeling sub-teams
• Longitudinal cohort study
• Community collaborations: peer counselling and social marketing
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Study Recruitment• Eligibility:
– Males 19 years of age or older– Designated recruitment (testing) sites: BCCDC STI & Bute St. Clinics,
Spectrum Health, Three Bridges, Dr. Richard Taylor’s office, HIM Sexual Health Centre
– Acute arm: negative or indeterminate EIA with positive NAAT– Recent arm: reactive EIA with known negative test result in last 12 months
• Study Activities:– Quantitative and qualitative interviews– Collection of results from follow-up blood work– Peer and professional counselling– To date, we have recruited 2 men in the acute arm and 1 man in the
recent arm
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Lessons Learned and Next Steps
• Advanced testing algorithm to identify acute and recent infections successfully implemented at 6 testing sites
• Low recruitment numbers – possible explanations?
• The roles of social marketing and public health– “What are you waiting for?” campaign at HIM under
development– Other social marketing initiatives planned
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CIHR Research Partners and Collaborators
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HIV Emerging Team
National HIV and Retroviral LaboratoriesJames Brooks
National Lab for HIV GeneticsPaul Sandstrom
Terry Trussler
North Carolina HIV/STD PreventionPeter Leone
Anthropology DepartmentJosephine McIntosh
Mathematics DepartmentDaniel Coombs
STI/HIV Prevention & ControlMichael Rekart
Mark GilbertGina Ogilvie
Malcolm SteinbergMathematical Modeling
Babak PourbodoulLaboratory Services
Mel Krajden
Benedikt Fisher
CIHR Recruitment SitesBCCDC STI & Bute St. Clinics
Spectrum HealthThree Bridges CHCDr. Richard Taylor
HIM Sexual Health Centre
Acknowledgments• CIHR Team: Malcolm Steinberg, Bill Coleman, Olivier Ferlatte,
Darlene Taylor, Carmen Rock, Mark Gilbert, Mike Rekart, and many others in the STI/HIV Division
• PHSA Labs: Mel Krajden, Darrel Cook, Wendy Mei, and the PHSA Lab Tech Team
• Recruitment Sites: Glenn Doupe, Melanie Achen, and everyone at our recruitment sites
• Community Partners: HIM – Jody Jollimore, Hans Bosgoed, Chris Hamilton; CBRC – Rick Marchand and Terry Trussler; BCPWA – Elgin Lim and peer counselling team; AIDS Vancouver Island – Liam ‘Captain’ Snowdon and peer counselling team
• UVic Anthropology Dep’t: Eric Roth, Josephine Macintosh
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Thank You!
• Michael Kwag
• CIHR Study Website: www.acutehivstudy.com
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