Philadelphia Department of Public Health, Philadelphia, Pennsylvania.
Philadelphia Department of Public Health, Philadelphia, Pennsylvania.
Am J Prev Med. 2021 Nov;61(5 Suppl 1):S151-S159. doi: 10.1016/j.amepre.2021.05.031.
The Ending the HIV Epidemic in the U.S. initiative considers cluster and outbreak response essential. This article describes the design, implementation, and early findings of a Philadelphia-based project to systematically assess sentinel cases among priority populations for improving public health infrastructure and preventing future outbreaks.
Sentinel HIV cases (i.e., early-stage or acute infection or molecular cluster cases) were identified among priority populations (Black and Hispanic/Latino men who have sex with men, youth aged 18-24 years, and transgender people who have sex with men). Chart abstraction and structured interview data were reviewed to determine themes and service gaps and to identify, prioritize, and implement recommendations. Interdisciplinary review teams included individuals with lived experience, frontline staff, and local agency leadership.
Data were collected during July 2019-December 2020 and analyzed for 53 of 126 sentinel cases of HIV diagnosed since July 1, 2018. The majority were men who have sex with men (79.3%), those aged 18-24 years (67.9%), and non-Hispanic Black (67.9%). More than half received sexually transmitted infection and HIV testing ≤3 years preceding HIV diagnosis (56.6% and 54.7%, respectively), had a healthcare visit within 12 months before diagnosis (64.2%), and had no evidence of pre-exposure prophylaxis awareness (58.5%). Project recommendations effectuated actions to improve pre-exposure prophylaxis provision, integrate sexually transmitted infection and HIV testing, and educate primary care providers.
HIV sentinel case review is a model for health departments to rapidly respond to recent transmission, identify missed HIV prevention opportunities, strengthen community partnerships, and implement programmatic and policy changes. Such efforts may prevent outbreaks and inform longer-term strategies.
美国终结艾滋病疫情倡议认为集群和疫情应对至关重要。本文描述了一个基于费城的项目，该项目旨在系统评估重点人群中的哨点病例，以改善公共卫生基础设施并预防未来的疫情，从而设计、实施和早期发现。
在重点人群（与男性发生性关系的黑人和西班牙裔/拉丁裔男性、18-24 岁的年轻人和与男性发生性关系的跨性别者）中确定哨点艾滋病毒病例（即早期或急性感染或分子集群病例）。对图表摘录和结构化访谈数据进行审查，以确定主题和服务差距，并确定、优先考虑和实施建议。跨学科审查团队包括有生活经验的个人、一线工作人员和当地机构领导。
数据于 2019 年 7 月至 2020 年 12 月收集，并对自 2018 年 7 月 1 日以来诊断的 126 例哨点艾滋病毒病例中的 53 例进行了分析。大多数为男男性行为者（79.3%）、年龄在 18-24 岁之间（67.9%）和非西班牙裔黑人（67.9%）。超过一半的人在艾滋病毒诊断前≤3 年内接受过性传播感染和艾滋病毒检测（分别为 56.6%和 54.7%），在诊断前 12 个月内有一次医疗就诊（64.2%），且无暴露前预防意识的证据（58.5%）。项目建议采取行动改善暴露前预防措施的提供、整合性传播感染和艾滋病毒检测，并对初级保健提供者进行教育。
艾滋病毒哨点病例审查是卫生部门快速应对近期传播、发现错过的艾滋病毒预防机会、加强社区伙伴关系以及实施计划和政策变革的一种模式。这些努力可能预防疫情并为更长期的战略提供信息。
