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, Price JT, Rosenberg NE, Rennie SM, Biddle AK, Miller WC. Hidden costs: The ethics of cost-effectiveness analyses for health interventions in resource-limited settings. Glob Public Health. 2017 Oct;12(10):1269-1281. doi: 10.1080/17441692.2016.1178319. Epub 2016 May 4. PMID: 27141969; PMCID: PMC5303190. [Full Text]

    2. Rutstein SE, Pettifor AE, Phiri S, Kamanga G, Hoffman IF, Hosseinipour MC, Rosenberg NE, Nsona D, Pasquale D, Tegha G, Powers KA, Phiri M, Tembo B, Chege W, Miller WC. 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 Mar 1;71(3):272-80. doi: 10.1097/QAI.0000000000000853. PMID: 26428231; PMCID: PMC4752378. [Full Text]

    3. Pettifor A, Corneli A, Kamanga G, McKenna K, Rosenberg NE, Yu X, Ou SS, Massa C, Wiyo P, Lynn D, Tharaldson J, Golin C, Hoffman I; HPTN 062 Study Protocol Team. 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 May 11;10(5):e0124452. doi: 10.1371/journal.pone.0124452. PMID: 25962118; PMCID: PMC4427322. [Full Text]

    4. Rosenberg NE, Pilcher CD, Busch MP, Cohen MS. How can we better identify early HIV infections? Curr Opin HIV AIDS. 2015 Jan;10(1):61-8. doi: 10.1097/COH.0000000000000121. PMID: 25389806; PMCID: PMC4490585. [Full Text]

    5. Rosenberg NE, Kamanga G, Phiri S, Nsona D, Pettifor A, Rutstein SE, Kamwendo D, Hoffman IF, Keating M, Brown LB, Ndalama B, Fiscus SA, Congdon S, Cohen MS, Miller WC. Detection of acute HIV infection: a field evaluation of the determine® HIV-1/2 Ag/Ab combo test. J Infect Dis. 2012 Feb 15;205(4):528-34. doi: 10.1093/infdis/jir789. Epub 2011 Dec 29. PMID: 22207651; PMCID: PMC3318673. [Full Text]

    6. Pettifor A, MacPhail C, Corneli A, Sibeko J, Kamanga G, Rosenberg N, Miller WC, Hoffman I, Rees H, Cohen MS; NIAID Center for HIV/AIDS Vaccine Immunology. Continued high risk sexual behavior following diagnosis with acute HIV infection in South Africa and Malawi: implications for prevention. AIDS Behav. 2011 Aug;15(6):1243-50. doi: 10.1007/s10461-010-9839-0. PMID: 20978833; PMCID: PMC3530889. [Full Text]

    7. Miller WC, Rosenberg NE, Rutstein SE, Powers KA. Role of acute and early HIV infection in the sexual transmission of HIV. Curr Opin HIV AIDS. 2010 Jul;5(4):277-82. doi: 10.1097/COH.0b013e32833a0d3a. PMID: 20543601; PMCID: PMC3130067. [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, Hauser BM, Ryan J, Miller WC. The effect of HIV counselling and testing on HIV acquisition in sub-Saharan Africa: a systematic review. Sex Transm Infect. 2016 Dec;92(8):579-586. doi: 10.1136/sextrans-2016-052651. Epub 2016 Aug 16. PMID: 27531527; PMCID: PMC5295132. [Full Text]

    2. Rosenberg NE, Westreich D, Bärnighausen T, Miller WC, Behets F, Maman S, Newell ML, Pettifor A. Assessing the effect of HIV counselling and testing on HIV acquisition among South African youth. AIDS. 2013 Nov 13;27(17):2765-73. doi: 10.1097/01.aids.0000432454.68357.6a. PMID: 23887069; PMCID: PMC4028633. [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;5(1):008011. doi: 10.4172/jaa.1000057. PMID: 25324925; PMCID: PMC4196702. [Full Text]

    4. Rosenberg NE, Pettifor AE, De Bruyn G, Westreich D, Delany-Moretlwe S, Behets F, Maman S, Coetzee D, Kamupira M, Miller WC. HIV testing and counseling leads to immediate consistent condom use among South African stable HIV-discordant couples. J Acquir Immune Defic Syndr. 2013 Feb 1;62(2):226-33. doi: 10.1097/QAI.0b013e31827971ca. PMID: 23117500; PMCID: PMC3548982. [Full Text]

    5. Rutstein SE, Brown LB, Biddle AK, Wheeler SB, Kamanga G, Mmodzi P, Nyirenda N, Mofolo I, Rosenberg NE, Hoffman IF, Miller WC. Cost-effectiveness of provider-based HIV partner notification in urban Malawi. Health Policy Plan. 2014 Jan;29(1):115-26. doi: 10.1093/heapol/czs140. Epub 2013 Jan 15. PMID: 23325584; PMCID: PMC3872371. [Full Text]

    6. Rosenberg NE. HIV testing to the test: does HIV testing promote HIV prevention in HIV-uninfected adults? Sex Transm Infect. 2016 Dec;92(8):566-567. doi: 10.1136/sextrans-2016-052640. Epub 2016 Aug 17. PMID: 27535764. [PubMed]

I-TEST and S-ITEST

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, Rachal L, Gbajabiamila T, Nwaozuru U, Obiezu-Umeh C, Hlatshwako T, Tembo M, Willis N, Nyagog CO, Vorkoper S, Sturke R, Rosenberg NE, Ojo V, Moses I, Ahmed N, Beima-Sofie K, Roberts ST, Kateera B, Namisoke-Magongo E, Mbizvo MT, Iwelunmor J, Ezechi O, Tucker JD. 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 May;27(Suppl 1):116-127. doi: 10.1007/s10461-022-03786-3. Epub 2022 Jul 12. PMID: 35829970; PMCID: PMC9277597. [Full Text]

    2. Tahlil KM, Nwaozuru U, Conserve DF, Onyeama UF, Ojo V, Day S, Ong JJ, Tang W, Rosenberg NE, Gbajabiamila T, Nkengasong S, Obiezu-Umeh C, Oladele D, Iwelunmor J, Ezechi O, Tucker JD. Crowdsourcing to support training for public health: A scoping review. PLOS Glob Public Health. 2023 Jul 26;3(7):e0002202. doi: 10.1371/journal.pgph.0002202. PMID: 37494311; PMCID: PMC10370701. [Full Text]

    3. Nwaozuru U, Tahlil KM, Obiezu-Umeh C, Gbaja-Biamila T, Asuquo SE, Idigbe I, BeLue R, Oladele D, Muessig KE, Rosenberg NE, Ong JJ, Musa AZ, Tang W, Ezechi O, Iwelunmor J, Tucker JD. Tailoring youth-friendly health services in Nigeria: a mixed-methods analysis of a designathon approach. Glob Health Action. 2021 Jan 1;14(1):1985761. doi: 10.1080/16549716.2021.1985761. PMID: 34904539; PMCID: PMC8676684. [Full Text]

    4. Iwelunmor J, Ezechi O, Obiezu-Umeh C, Gbaja-Biamila T, Musa AZ, Nwaozuru U, Xian H, Oladele D, Airhihenbuwa CO, Muessig K, Rosenberg N, Conserve DF, Ong JJ, Nkengasong S, Day S, Tahlil KM, BeLue R, Mason S, Tang W, Ogedegbe G, Tucker JD. 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 Feb;36(2):64-72. doi: 10.1089/apc.2021.0202. PMID: 35147463; PMCID: PMC8861905. [Full Text]

    5. Iwelunmor J, Tucker JD, Obiezu-Umeh C, Gbaja-Biamila T, Oladele D, Nwaozuru U, Musa AZ, Airhihenbuwa CO, Muessig K, Rosenberg N, BeLue R, Xian H, Conserve DF, Ong JJ, Zhang L, Curley J, Nkengasong S, Mason S, Tang W, Bayus B, Ogedegbe G, Ezechi O. The 4 Youth by Youth (4YBY) pragmatic trial to enhance HIV self-testing uptake and sustainability: Study protocol in Nigeria. Contemp Clin Trials. 2022 Mar;114:106628. doi: 10.1016/j.cct.2021.106628. Epub 2021 Nov 17. PMID: 34800699; PMCID: PMC9358609. [Full Text]

    6. Tahlil KM, Ong JJ, Rosenberg NE, Tang W, Conserve DF, Nkengasong S, Muessig KE, Iwelunmor J, Ezechi O, Gbaja-Biamila T, Aliyu SH, Obiezu-Umeh C, Kapogiannis B, Tucker JD. Verification of HIV Self-Testing Use and Results: A Global Systematic Review. AIDS Patient Care STDS. 2020 Apr;34(4):147-156. doi: 10.1089/apc.2019.0283. PMID: 32324482; PMCID: PMC7194324. [Full Text]

    7. Oladele D, Iwelunmor J, Gbajabiamila T, Obiezu-Umeh C, Okwuzu JO, Nwaozuru U, Musa AZ, Idigbe I, Tahlil K, Tang W, Conserve DF, Rosenberg NE, David AN, Tucker J, Ezechi O. The 4 Youth By Youth mHealth Photo Verification App for HIV Self-testing in Nigeria: Qualitative Analysis of User Experiences. JMIR Form Res. 2021 Nov 17;5(11):e25824. doi: 10.2196/25824. PMID: 34787579; PMCID: PMC8663582. [Full Text]

    8. Rosenberg NE, Obiezu-Umeh C, Gbaja-Biamila T, Tahlil KM, Nwaozuru U, Oladele D, Musa AZ, Idigbe I, Okwuzu J, David AN, Bamidele TA, Tang W, Ezechi O, Tucker JD, Iwelunmor J. Strategies for enhancing uptake of HIV self-testing among Nigerian youths: a descriptive analysis of the 4YouthByYouth crowdsourcing contest. BMJ Innov. 2021 Jul;7(3):590-596. doi: 10.1136/bmjinnov-2020-000556. Epub 2018 Oct 21. PMID: 35965675; PMCID: PMC9369456. [Full Text]

    9. Tahlil KM, Obiezu-Umeh C, Gbajabiamila T, Nwaozuru U, Oladele D, Musa AZ, Idigbe I, Okwuzu J, David AN, Bamidele TA, Airhihenbuwa CO, Rosenberg NE, Tang W, Ong JJ, Conserve DF, Iwelunmor J, Ezechi O, Tucker JD. A designathon to co-create community-driven HIV self-testing services for Nigerian youth: findings from a participatory event. BMC Infect Dis. 2021 May 31;21(1):505. doi: 10.1186/s12879-021-06212-6. PMID: 34059014; PMCID: PMC8166032. [Full Text]

    10. Asuquo SE, Tahlil KM, Muessig KE, Conserve DF, Igbokwe MA, Chima KP, Nwanunu EC, Elijah LP, Day S, Rosenberg NE, Ong JJ, Nkengasong S, Tang W, Obiezu-Umeh C, Nwaozuru U, Merino Y, Gbaja-Biamila T, Oladele D, Iwelunmor J, Ezechi O, Tucker JD. Youth engagement in HIV prevention intervention research in sub-Saharan Africa: a scoping review. J Int AIDS Soc. 2021 Feb;24(2):e25666. doi: 10.1002/jia2.25666. PMID: 33569913; PMCID: PMC7876473. [Full Text]