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Acute HIV Follow-Up in NC Presented by. Muhammad “Maxi” Mackalo, DIS. Background of ACUTE HIV. STAT: Screening and Testing for Active Transmission The program has been operating since 2002

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Acute hiv follow up in nc presented by

Acute HIV Follow-Up in NCPresented by

Muhammad “Maxi” Mackalo, DIS


Background of acute hiv

Background of ACUTE HIV

STAT: Screening and Testing for Active Transmission

The program has been operating since 2002

Dr Leone, Medical Director, Communicable Disease Branch is one of the co-founders of the study and is currently superheading the program operation


Detection testing

Detection/Testing

Tests are analyze at state-funded public health virology & serology laboratory;

Serum specimen are tested using a method called pooling & nucleic-acid testing using ultrasensitive HIV RNA RT-PCR test;

Results obtained are confirmed using WB;

In 2002, 4.9 cases per 10,000 clients were identified as a case


Function of stat acute program

Function of STAT/ACUTE Program

  • To detect acute HIV;

  • Notify, Counsel, & Interview client;

  • Assist them get into care; and

  • Notify, counsel, and test their partners


Symptoms

Symptoms

Acute Retroviral syndrome (Mostly Flu-like symptoms) such as:

Fever, rash, headache, night sweats, fatigue, malaise, athralgia, myalgia, pharyngitis, swollen lymph nodes, weight Loss (~ 6 lbs. or more), loss of appetite, oral ulcers, nausea, vomiting and diarrhea


Risk factors

Risk Factors

Unprotected receptive & insertive anal sex;

The sharing of IV drug paraphernalia ;

Unprotected vaginal sex;

Receptive oral sex with a male partner;

Exposure to HIV/AIDS via any exchange of bodily fluids (ex: needle stick) .


Diagnosis

Diagnosis

All clients with (-) EIA (+) NAAT results, as well as EIA (+) WB (-) or Indeterminate with a (+) NAAT need to be followed by DIS for notification, counseling, interview & repeat HIV serology for confirmation of HIV infection

Clients with a (-) HIV antibody test within the previous month followed by (+) EIA/WB test are also identified as acute HIV cases


Diagnosis cont

Diagnosis Cont.

  • Community Acute:

    • Detected outside NCSLPH; and

    • Initial testing is performed by a PMD or another community clinic;


Identification of comm acute

Identification of Comm. Acute

  • EIA/WB (-) and HIV RNA (+)

  • EIA(+), (Indeterminate / (-) WB) and a detectable HIV RNA PCR or Viral Load

  • EIA (+), (Indeterminate / (-) WB ) with a documented EIA/WB in past month

  • EIA (+), Indeterminate / (-) WB and a (+) EIA/WB within a month of Indeterminate test

  • EIA/WB (+) within a month of EIA/WB (-)


Identification of comm recent

Identification of Comm. Recent

  • EIA/WB (+) and a documented EIA (-) within last 6 mths of initial positive test;

    • EIA (-) < 3 mths from date of first positive test;

    • Patient noted signs/sympt of acute retroviral syndrome < 1 mth from date of first positive test; and/or

    • Patient diagnosed/Rx’d for an STD < 1 mth from date of first positive test


Referral

Referral

Persons identified with acute HIV are offered immediate access to care via the Acute HIV Program @ UNC

Statewide network of providers

Medical Evaluation and assessment by a clinician familiar with acute HIV infection

Receive information about HIV & acute HIV infection

Financial, social & psychological assistance available

Discuss concern(s) with diagnosis and treatment

Provide information for care options and applicable research opportunities


Dis duties responsibilities

DIS Duties/Responsibilities

Locate, Notify, Counsel, Interview, and draw repeat specimen

Transport to first medical visit

Contact tracing for partners & suspects within 72 hours

Schedule follow up visits within a week after interview with all clients

Additional STAT research program -

1. Obtain consent to allow initial blood samples to go to UNC for testing

2. HIPAA release form to discuss sexual -social networks for state epidemiology and outbreak information


Acknowledgement

Acknowledgement:

Many thanks to the following in preparation of this presentation:

Todd Vanhoy: NC Field Service Mgr.

Rhonda Ashby: Asst. Field Service Mgr.

Dr. Peter Leone: NC Medical Director, Communicable Disease Branch

Joann Kuruc: Acute HIV Program Mgr.


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