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

michael.kwag@bccdc.ca

• CIHR Study Website: www.acutehivstudy.com

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