1. STAT Steve Beagle UNC CHAVI Field Coordinator
University of North Carolina at Chapel Hill

2. Acknowledgements
North Carolina D.I.S. and all Public Health Colleagues and Clients
Evelyn Foust, Peter Leone, Todd VanHoy, and Rhonda Ashby (HIV/STD Prevention and Care)
JoAnn Kuruc - STAT Program, University of North Carolina (UNC)

4. What is STAT?
Acronym for “Screening and Tracing of Active Transmission” (Acute HIV)
Collaboration between UNC and the NC HIV/STD Prevention and Care Branch (Field Services Unit)
Statewide program that has enormous public health impact

5. Acute HIV The STAT Program

6. Public Health Impact? Most infectious period of HIV infection
Early linkage to care
HIV education to help prevent downstream transmissions
Rapid partner contact and tracing, counseling and testing
Research: medical evaluations, treatment interventions and vaccine studies

7. History of STAT Pilot project in 2001: 8,155 Specimens pooled
Two [2] “two month” testing periods (May-June and August-September)
Identified five antibody negative, HIV RNA positive samples (four were positive for acute HIV infection and one was a false positive)
November 2002: STAT Program Implemented Statewide (SLPH/Field Services/UNC)

8. STAT Program Testing sites: >110 publicly funded sites across NC
Laboratory detection of incident HIV infection
Routine HIV Antibody (Ab or EIA) testing
HIV-1 QL RNA screening of all Ab (-) specimens
Rapid notification of RNA (+) Ab (-) individuals by the NC DHHS STAT DIS
Rapid partner notification and testing
Systematic data collection on social/sexual networks
Ongoing monitoring of transmission patterns by the UNC/NC DHHS STAT Team

9. STAT Program Classification System
STAT Acutes
Community Acutes
Community Recents

10. STAT Acutes
One of the following test result combinations from the North Carolina State Laboratory of Public Health (NCSLPH)
EIA (-), RNA (+)
EIA (+), RNA (+), WB (-)
EIA (+), RNA (+), WB (I)
(“I”= indeterminate)

11. Community Acutes HIV test results usually the same as with STAT acutes
Can test EIA (+) WB (+) with documentation of a negative HIV antibody test within the past 30 days.
Cases are discovered by PMDs, hospitals and Field Services
HIV testing is usually performed in labs other than SLPH (i.e. LabCorp, Quest)

12. Community Recent
EIA/WB(+) with a documented EIA(-) test within the previous 6 months
Our focus: Community recents with …
An EIA(-) test ≤ 3 months of the EIA/WB+ result
An STD (diagnosed and treated) ≤ 1 month of the first HIV positive test
Symptoms consistent with an acute retroviral syndrome (ARS) ≤ 1 month of the first HIV positive test
Consider last exposure and any circumstances that would clearly suggest transmission 3 months prior to an +EIA/WB

13. Acute Retroviral Syndrome or ARS
Often overlooked by patients and/or physicians
Frequently misdiagnosed as:
Flu or viral syndrome
Meningitis
Rash
Rocky Mountain Spotted Fever

14. ARS (continued) 5. Urinary Tract Infection Sore throat/pharyngitis
Upper Respiratory Infection
“Viral Syndrome” “Viral illness”
Herpes
Mononucleosis (mono)

15. STAT Acutes How are they identified? ?
The NCSLPH detects a positive pool. The pool is deconstructed to identify the positive sample – John Barnhart (ESSU) notified.
John notifies Rhonda Ashby, who then notifies the appropriate regional supervisor
Regional supervisor assigns the case to a STAT D.I.S. in their region
STAT D.I.S. begins investigation, locates and interviews the “possible” acutely HIV infected individual within 72 hours of the testing result

16. STAT Index Case Protocol
STAT Case
Possible acute HIV Infection
STAT Notification
Confirmatory
Test
HIV Antibody
and RNA Testing •
DIS Interview
Referral to Care
Contact < 72 hrs
Contact < 8 weeks
Contact > 8 weeks
STAT
Post -
Exposure
Protocol
Contact Protocol
Routine Partner
Notification Ab + or (
) RNA +
Confirmed Acute HIV +
Repeat Testing
Weeks 4 & 12
False
RNA
Positive
STAT Index Case Protocol

17. Post test counseling and field blood
What happens once a person is identified and suspected of having acute HIV infection?
STAT DIS locates Index
Post test counseling and field blood
“It is likely that you are infected with HIV”
DIS conducts a detailed patient interview
Discuss acute HIV’s impact on personal and public health
Elicit partner information
Discuss importance of medical evaluation
Assess for recent viral symptoms, illnesses and STDs

18. ? Anything else “Health Information Release” form
Allows evaluation of STAT and HIV incidence in NC
Allows DIS to schedule the appointment at UNC or with other ID specialist and to discuss the patient with the STAT and medical team
“Blood Storage” consent:
Allows specimens to be used in research
Medical Evaluation
Arrange medical evaluation (UNC or local provider)
Provide transportation to UNC or other ID specialist for a free medical exam with a doctor who specializes in Acute HIV infection
Care options and (if available) study opportunities are addressed during the ID visit

23. …and the STAT patient’s partners?
Partners exposed < 72 hours prior
STAT DIS calls Dr. Leone to discuss
“You may have been exposed to HIV”
Draw field blood - flag for individual RNA testing
Cluster interview

24. …and the STAT patient’s partners?
Partner exposure >72 hours and <8 weeks
“You may have been exposed to HIV”
Obtain field blood – flag for RNA testing
Cluster interview

25. …and the STAT patient’s partners?
Partners exposed >8 weeks
Routine partner notification within 14 days after WB confirmation of the STAT acute
Cluster interview

26. Courtesy of Dr. Lisa Hightow-Weidman21 W 23 H
30’s W
30’s W
30’s W 21 W 26 W 27 W
30’s W
30’s W
15 male
partners
30’s W 27 W
30’s W
20+ Partners 25 B
9 Partners: addresses/screen
names only,
Age
race
Chronic HIV
Acute HIV
30’s W
HIV and/or
Syphilis negative
Syphilis 29 W
Not tested/
Unknown
HIV status
HIV/Syphilis
coinfection 31 B
Crystal Meth
Use
Gay.com
Manhunt 30 W
AOL
Courtesy of Dr. Lisa Hightow-Weidman
College Student
Non-Internet
sex partner 26

27. Duke-UNC Acute HIV Infection Research Consortium
Research opportunities for patients with Acute and Recent HIV Infection:
“Treatment of Acute HIV Infection with Once Daily Atripla” (24 month treatment study which supplies Atripla)
“Longitudinal Assessment of Acute/Recent HIV Infection” (Adds to limited scientific knowledge currently available regarding acute/recent infection) 27

28. Duke-UNC Acute HIV Infection Research Consortium
3) “CHAVI 001: Acute HIV-1 Infection Prospective Cohort Study”
Acquire information to develop an HIV vaccine
The most relevant information may come from people with acute HIV infection and their partners 28