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STAT

STAT. Steve Beagle UNC CHAVI Field Coordinator University of North Carolina at Chapel Hill. Acknowledgements. North Carolina D.I.S. and all Public Health Colleagues and Clients Evelyn Foust, Peter Leone, Todd VanHoy, and Rhonda Ashby (HIV/STD Prevention and Care)

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STAT

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  1. STAT Steve Beagle UNC CHAVI Field Coordinator University of North Carolina at Chapel Hill

  2. Acknowledgements • North Carolina D.I.S. and all Public Health Colleagues and Clients • Evelyn Foust, Peter Leone, Todd VanHoy, and Rhonda Ashby (HIV/STD Prevention and Care) • JoAnn Kuruc - STAT Program, University of North Carolina (UNC)

  3. What is STAT? • Acronym for “Screening and Tracing of Active Transmission” (Acute HIV) • Collaboration between UNC and the NC HIV/STD Prevention and Care Branch (Field Services Unit) • Statewide program that has enormous public health impact

  4. Acute HIV The STAT Program

  5. Public Health Impact? Most infectious period of HIV infection • Early linkage to care • HIV education to help prevent downstream transmissions • Rapid partner contact and tracing, counseling and testing • Research: medical evaluations, treatment interventions and vaccine studies

  6. History of STAT • Pilot project in 2001: 8,155 Specimens pooled • Two [2] “two month” testing periods (May-June and August-September) • Identified five antibody negative, HIV RNA positive samples (four were positive for acute HIV infection and one was a false positive) • November 2002: STAT Program Implemented Statewide (SLPH/Field Services/UNC)

  7. STAT Program • Testing sites: >110 publicly funded sites across NC • Laboratory detection of incident HIV infection • Routine HIV Antibody (Ab or EIA) testing • HIV-1 QL RNA screening of all Ab (-) specimens • Rapid notification of RNA (+) Ab (-) individuals by the NC DHHS STAT DIS • Rapid partner notification and testing • Systematic data collection on social/sexual networks • Ongoing monitoring of transmission patterns by the UNC/NC DHHS STAT Team

  8. STAT ProgramClassification System • STAT Acutes • Community Acutes • Community Recents

  9. STAT Acutes • One of the following test result combinations from the North Carolina State Laboratory of Public Health (NCSLPH) • EIA (-), RNA (+) • EIA (+), RNA (+), WB (-) • EIA (+), RNA (+), WB (I) (“I”= indeterminate)

  10. Community Acutes • HIV test results usually the same as with STAT acutes • Can test EIA (+) WB (+) with documentation of a negative HIV antibody test within the past 30 days. • Cases are discovered by PMDs, hospitals and Field Services • HIV testing is usually performed in labs other than SLPH (i.e. LabCorp, Quest)

  11. Community Recent • EIA/WB(+) with a documented EIA(-) test within the previous 6 months • Our focus: Community recents with … • An EIA(-) test ≤ 3 months of the EIA/WB+ result • An STD (diagnosed and treated) ≤ 1 month of the first HIV positive test • Symptoms consistent with an acute retroviral syndrome (ARS) ≤ 1 month of the first HIV positive test • Consider last exposure and any circumstances that would clearly suggest transmission 3 months prior to an +EIA/WB

  12. Acute Retroviral Syndrome or ARS Often overlooked by patients and/or physicians Frequently misdiagnosed as: • Flu or viral syndrome • Meningitis • Rash • Rocky Mountain Spotted Fever

  13. ARS (continued) 5. Urinary Tract Infection • Sore throat/pharyngitis • Upper Respiratory Infection • “Viral Syndrome” “Viral illness” • Herpes • Mononucleosis (mono)

  14. STAT AcutesHow are they identified ? ? • The NCSLPH detects a positive pool. The pool is deconstructed to identify the positive sample – John Barnhart (ESSU) notified. • John notifies Rhonda Ashby, who then notifies the appropriate regional supervisor • Regional supervisor assigns the case to a STAT D.I.S. in their region • STAT D.I.S. begins investigation, locates and interviews the “possible” acutely HIV infected individual within 72 hours of the testing result

  15. STAT Index Case Protocol Ab + or Confirmatory Ab ( - ) RNA + STAT Case Confirmed Acute HIV + Test Possible acute HIV Infection HIV Antibody and RNA Testing STAT Notification Ab + Ab - False Repeat Testing RNA Weeks 4 & 12 Ab - Positive STAT STAT Post Post - - Exposure Exposure Contact < 72 hrs Protocol Protocol • DIS Interview STAT Contact < 8 weeks • Referral to Care Contact Protocol Routine Partner Contact > 8 weeks Notification Protocol

  16. What happens once a person is identified and suspected of having acute HIV infection? STAT DIS locates Index • Post test counseling and field blood • “It is likely that you are infected with HIV” • DIS conducts a detailed patient interview • Discuss acute HIV’s impact on personal and public health • Elicit partner information • Discuss importance of medical evaluation • Assess for recent viral symptoms, illnesses and STDs

  17. Anything else ? “Health Information Release” form • Allows evaluation of STAT and HIV incidence in NC • Allows DIS to schedule the appointment at UNC or with other ID specialist and to discuss the patient with the STAT and medical team “Blood Storage” consent: • Allows specimens to be used in research Medical Evaluation • Arrange medical evaluation (UNC or local provider) • Provide transportation to UNC or other ID specialist for a free medical exam with a doctor who specializes in Acute HIV infection • Care options and (if available) study opportunities are addressed during the ID visit

  18. …and the STAT patient’s partners? Partners exposed < 72 hours prior • STAT DIS calls Dr. Leone to discuss • “You may have been exposed to HIV” • Draw field blood - flag for individual RNA testing • Cluster interview

  19. …and the STAT patient’s partners? Partner exposure >72 hours and <8 weeks • “You may have been exposed to HIV” • Obtain field blood – flag for RNA testing • Cluster interview

  20. …and the STAT patient’s partners? • Partners exposed >8 weeks • Routine partner notification within 14 days after WB confirmation of the STAT acute • Cluster interview

  21. 21 W 30’s W 30’s W 23 H 30’s W 21 W 27 W 26 W 30’s W 30’s W 30’s W 15 male partners 27 W 20+ Partners 30’s W 25 B 9 Partners: E-mail addresses/screen names only, Age race Chronic HIV Acute HIV 30’s W HIV and/or Syphilis negative Syphilis 29 W Not tested/ Unknown HIV status HIV/Syphilis coinfection 31 B Crystal Meth Use Gay.com Manhunt AOL 30 W Courtesy of Dr. Lisa Hightow-Weidman College Student Non-Internet sex partner

  22. Duke-UNC Acute HIV Infection Research Consortium Research opportunities for patients with Acute and Recent HIV Infection: “Treatment of Acute HIV Infection with Once Daily Atripla” (24 month treatment study which supplies Atripla) “Longitudinal Assessment of Acute/Recent HIV Infection” (Adds to limited scientific knowledge currently available regarding acute/recent infection)

  23. Duke-UNC Acute HIV Infection Research Consortium 3) “CHAVI 001: Acute HIV-1 Infection Prospective Cohort Study” Acquire information to develop an HIV vaccine The most relevant information may come from people with acute HIV infection and their partners

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