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Global Health: Science and Practice

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Open Access

Go Where the Virus Is: An HIV Micro-epidemic Control Approach to Stop HIV Transmission

Michael M. Cassell, Rose Wilcher, Reshmie A. Ramautarsing, Nittaya Phanuphak and Timothy D. Mastro
Global Health: Science and Practice December 2020, 8(4):614-625; https://doi.org/10.9745/GHSP-D-19-00418
Michael M. Cassell
aFHI 360, Hanoi, Vietnam.
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  • For correspondence: mcassell@fhi360.org
Rose Wilcher
bFHI 360, Durham, NC, USA.
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Reshmie A. Ramautarsing
cInstitute of HIV Research and Innovation, Bangkok, Thailand.
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Nittaya Phanuphak
cInstitute of HIV Research and Innovation, Bangkok, Thailand.
dCenter of Excellence in Transgender Health, Chulalongkorn University, Bangkok, Thailand.
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Timothy D. Mastro
bFHI 360, Durham, NC, USA.
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    Liz Brenda Kandeyi, nurse (left), takes a client through the steps for clinical services at Kikuyu Sasa Center, Nairobi, Kenya. © 2017 Nancy Coste/FHI 360

  • FIGURE 1.
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    FIGURE 1.

    An HIV Micro-epidemic Control Model Aims to Prioritize and Focus Treatment and Prevention Efforts Where They Can Have the Greatest Impacts: Among a Shrinking Proportion of Individuals and Risk Networks With the Greatest Viral Burdens

    Abbreviations: AHI, acute HIV infection; ART, antiretroviral therapy; HIV+, HIV-positive; HIV-, HIV-negative; PLHIV, people living with HIV; PrEP, pre-exposure prophylaxis.

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    FIGURE 2.

    The Natural History of HIV Disease Progression in the Absence of Antiretroviral Therapy, Variable Transmission Probabilities Associated With Viral Burden, and Capacities for Detection of HIV Infection Through Different Diagnostics

    Abbreviations: Ag, antigen; Ab, antibody; PCR, polymerase chain reaction.

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    FIGURE 3.

    An Algorithm for Routine Screening for Acute HIV Infection in Populations Facing Elevated HIV Infection Risks

    Abbreviations: ART, antiretroviral therapy; DBS, dried blood spot; HTS, HIV testing services; PCR, polymerase chain reaction; PrEP, pre-exposure prophylaxis; VL, viral load.a Individuals with nonreactive results on the first or “screening” test would be notified as likely uninfected but as falling within a window period for possible HIV infection pending the outcome of the DBS HIV PCR testing.

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    FIGURE 4.

    An Illustrative Workflow for Acute HIV Infection Screening, Additionally Applying Recency Testing Data to Help Improve Focus

    Abbreviations: Ab+, antibody positive; Ab−, antibody negative; AHI, acute HIV infection; Ag+, antigen positive; Ag−, antigen negative; ART, antiretroviral therapy; HIV+, HIV-positive; PLHIV, people living with HIV.

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Global Health: Science and Practice: 8 (4)
Global Health: Science and Practice
Vol. 8, No. 4
December 23, 2020
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Go Where the Virus Is: An HIV Micro-epidemic Control Approach to Stop HIV Transmission
Michael M. Cassell, Rose Wilcher, Reshmie A. Ramautarsing, Nittaya Phanuphak, Timothy D. Mastro
Global Health: Science and Practice Dec 2020, 8 (4) 614-625; DOI: 10.9745/GHSP-D-19-00418

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Go Where the Virus Is: An HIV Micro-epidemic Control Approach to Stop HIV Transmission
Michael M. Cassell, Rose Wilcher, Reshmie A. Ramautarsing, Nittaya Phanuphak, Timothy D. Mastro
Global Health: Science and Practice Dec 2020, 8 (4) 614-625; DOI: 10.9745/GHSP-D-19-00418
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  • Article
    • INTRODUCTION
    • ENVISIONING A MICRO-EPIDEMIC CONTROL APPROACH THAT DIFFERENTIATES SUPPORT BASED ON VIRAL BURDEN
    • THE CHALLENGE OF ACUTE HIV INFECTION
    • POOLED PCR TO FACILITATE DETECTION OF AND INTERVENTION DURING AHI
    • COMBINING AHI SCREENING WITH RECENCY TESTING TO FACILITATE EARLIER HIV DIAGNOSIS AND INTERVENTION
    • CONCLUSIONS
    • Acknowledgments
    • Notes
    • REFERENCES
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