Evaluation of HIV Diagnostics and Testing Approaches

Acute HIV Infection and Detection

Acute HIV Infection (AHI) is the brief period following HIV acquisition when the HIV virus replicates rapidly causing hyper-infectiousness. Although AHI likely contributes to a disproportionate share of transmission events, it is rarely diagnosed, since most HIV diagnostics cannot detect HIV this early. I assessed the performance characteristics of a new AHI point-of-care diagnostic test and later wrote a review of AHI detection strategies. I have participated on assessments of behavioral and biomedical prevention strategies for patients with AHI in Malawi and South Africa.

    1. Rutstein SE, et al. Hidden costs: The ethics of cost-effectiveness analyses for health interventions in resource-limited settings. Glob Public Health. 2017. [Full Text]

    2. Rutstein SE, et al. Incorporating Acute HIV Screening into Routine HIV Testing at Sexually Transmitted Infection Clinics, and HIV Testing and Counseling Centers in Lilongwe, Malawi. J Acquir Immune Defic Syndr. 2016. [Full Text]

    3. Pettifor A, et al. HPTN 062: A Pilot Randomized Controlled Trial Exploring the Effect of a Motivational-Interviewing Intervention on Sexual Behavior among Individuals with Acute HIV Infection in Lilongwe, Malawi. PLoS One. 2015. [Full Text]

    4. Rosenberg NE, et al. How can we better identify early HIV infections? Curr Opin HIV AIDS. 2015. [Full Text]

    5. Rosenberg NE, et al. Detection of acute HIV infection: a field evaluation of the determine® HIV-1/2 Ag/Ab combo test. J Infect Dis. 2012. [Full Text]

    6. Pettifor A, et al. Continued high risk sexual behavior following diagnosis with acute HIV infection in South Africa and Malawi: implications for prevention. AIDS Behav. 2011. [Full Text]

    7. Miller WC, et al. Role of acute and early HIV infection in the sexual transmission of HIV. Curr Opin HIV AIDS. 2010. [Full Text]

Impact of HIV Testing on HIV Acquisition

My dissertation examined the impact of HIV testing on sexual behavior and HIV transmission in the South African context. In one analysis, I found that HIV testing led to a 40% reduction in HIV acquisition among a cohort of South African youth aged 15-24 years-old. In a second analysis, I found that stable HIV mixed-status couples changed their sexual behavior rapidly after learning their couple status. I then developed an “Awareness Framework.” In this Framework I described nine possible patterns of awareness within HIV mixed-status couples, based on awareness of one’s own HIV status and one’s partner’s HIV status. I observed that one pattern (mutual awareness by both partners) led to a range of HIV prevention behaviors, such as condoms. I hypothesized that couple-based strategies would also prove important for adoption and adherence to new biomedical HIV prevention strategies.

    1. Rosenberg NE, et al. The effect of HIV counselling and testing on HIV acquisition in sub-Saharan Africa: a systematic review. Sex Transm Infect. 2016. [Full Text]

    2. Rosenberg NE, et al. Assessing the effect of HIV counselling and testing on HIV acquisition among South African youth. AIDS. 2013. [Full Text]

    3. Rosenberg NE, Pettifor AE, Miller WC. The Awareness Framework: A Novel Approach for Understanding HIV Testing and Disclosure in HIV-discordant Dyads. J Antivir Antiretrovir. 2013. [Full Text]

    4. Rosenberg NE, et al. HIV testing and counseling leads to immediate consistent condom use among South African stable HIV-discordant couples. J Acquir Immune Defic Syndr. 2013. [Full Text]

    5. Rutstein SE, et al. Cost-effectiveness of provider-based HIV partner notification in urban Malawi. Health Policy Plan. 2014. [Full Text]

    6. Rosenberg NE. HIV testing to the test: does HIV testing promote HIV prevention in HIV-uninfected adults? Sex Transm Infect. 2016. [PubMed]

I-TEST and S-TEST

Project Dates:
07/2023 - 06/2028

Role:
Co-Investigator

PI:
Juliet Iwelunmor

Funder:
NICHD
UGH1 HD1113156

Project Dates:
09/2018 - 08/2023

Role:
Co-Investigator

PI:
Juliet Iwelunmor

Funder:
NICHD
UH3 HD096929

I-TEST: Innovative Tools to Expand Youth-Friendly HIV Self-Testing

The I-TEST project developed and evaluated participatory interventions focused on HIV testing for at-risk youth in Nigeria. The project combined the wisdom of youth as partners and local communities to define, implement, and evaluate innovative HIV interventions.

S-TEST: Sustainable Tools to Expand Youth-Friendly HIV Self-Testing

This study will enhance essential HIV prevention services and increase our understanding of how to sustain them. The project draws on the unique strengths of Nigerian youth. This study will help inform the sustainment of HIV prevention strategies that reduce the acquisition of HIV in at-risk youth in low- and middle-income countries.

    1. Tahlil KM, et al. Assessing Engagement of Adolescents and Young Adults (AYA) in HIV Research: A Multi-method Analysis of a Crowdsourcing Open Call and Typology of AYA Engagement in Sub-Saharan Africa. AIDS Behav. 2023. [Full Text]

    2. Tahlil KM, et al. Crowdsourcing to support training for public health: A scoping review. PLOS Glob Public Health. 2023. [Full Text]

    3. Nwaozuru U, et al. Tailoring youth-friendly health services in Nigeria: a mixed-methods analysis of a designathon approach. Glob Health Action. 2021. [Full Text]

    4. Iwelunmor J, et al. Enhancing HIV Self-Testing Among Nigerian Youth: Feasibility and Preliminary Efficacy of the 4 Youth by Youth Study Using Crowdsourced Youth-Led Strategies. AIDS Patient Care STDS. 2022. [Full Text]

    5. Iwelunmor J, et al. The 4 Youth by Youth (4YBY) pragmatic trial to enhance HIV self-testing uptake and sustainability: Study protocol in Nigeria. Contemp Clin Trials. 2022. [Full Text]

    6. Tahlil KM, et al. Verification of HIV Self-Testing Use and Results: A Global Systematic Review. AIDS Patient Care STDS. 2020. [Full Text]

    7. Oladele D, et al. The 4 Youth By Youth mHealth Photo Verification App for HIV Self-testing in Nigeria: Qualitative Analysis of User Experiences. JMIR Form Res. 2021. [Full Text]

    8. Rosenberg NE, et al. Strategies for enhancing uptake of HIV self-testing among Nigerian youths: a descriptive analysis of the 4YouthByYouth crowdsourcing contest. BMJ Innov. 2021. [Full Text]

    9. Tahlil KM, et al. A designathon to co-create community-driven HIV self-testing services for Nigerian youth: findings from a participatory event. BMC Infect Dis. 2021. [Full Text]

    10. Asuquo SE, et al. Youth engagement in HIV prevention intervention research in sub-Saharan Africa: a scoping review. J Int AIDS Soc. 2021. [Full Text]