The Center for Infectious Diseases (CID) at the University of North Carolina-Chapel Hill School of Medicine has received a $1.8 million grant from CDC and the Health Resources and Services Administration. The center recently established a demonstration project in UNC Hospitals' Infectious Diseases Outpatient Clinic (IDOC).

The clinic treats about 1,500 HIV-positive North Carolinians annually. If successful, the project may shape the national approach to HIV outpatient therapy. "Despite extensive preventive efforts targeted at people not infected with HIV, 40,000 new HIV cases are identified in the U.S. annually, a number that has remained somewhat consistent," said Dr. Evelyn Byrd Quinlivan, assistant professor of medicine at UNC and medical director of IDOC.

In 1999, CDC requested that the Institute of Medicine form a Committee on HIV Prevention Strategies in the United States. Dr. Myron S. Cohen, director of the CID, was on the committee. In 2001, Cohen and colleagues published a book, No Time to Lose: Getting More From HIV Prevention, with the underlying premise that, "Each new infection begins with someone who is already infected." Thus, prevention is enhanced by also targeting infected people.

The committee's report recommended that prevention services for HIV patients become a standard of care in all clinical settings including primary care centers, STD clinics, drug treatment facilities and mental health centers, and it called for research proposals to develop effective "secondary prevention" programs to integrate into HIV treatment. UNC's proposals were funded.

Caregivers in the UNC clinic will be trained to enhance their counseling and behavioral intervention skills. For more complex situations -- such as people who do not understand how to use condoms or who do not feel safe disclosing their HIV status to partners -- a clinic counselor will be available. Such efforts will be combined with medical therapy to reduce blood HIV levels and lower the amount of virus that is shed.

Experts predict incorporating drug therapy with counseling and education will be more effective than either effort alone. To assess outcome specifics, the program will measure the degree to which self-reports of HIV risk behaviors, STD infections and HIV status-disclosure outcomes are improved by integrating prevention counseling services into primary care.

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