4259.0: Tuesday, November 14, 2000 - Board 3

Abstract #4762

Use of STARHS to estimate incidence among injection drug users admitted to drug treatment

Martha S. Miller, MPH1, Keith A. Bordelon, MSPH1, Keith M. Sabin, PhD, MPH1, Laurie A. Linley, MPH1, Janet E. Royalty, MS1, Denise L. Kothe2, and Richard W. Steketee, MD, MPH3. (1) National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, MS: E46, Atlanta, GA 30333, 404-639-4482, mnm7@cdc.gov, (2) National Center for Environmental Health, Centers for Disease Control and Prevention (CDC), (3) National Center for Infectious Disease, Centers for Disease Control and Prevention (CDC)

Objective: To estimate and compare HIV seroincidence among injection drug users (IDUs) admitted to drug treatment centers (DTCs) using two different testing methods: the Serologic Testing Algorithm for Recent HIV Seroconversion (STARHS), which requires only a single blood specimen, and record based incidence studies (RBIS), which require multiple blood specimens. Methods: STARHS - Anonymous unlinked HIV testing was conducted on residual blood routinely collected from IDUs during intake proceedings in 2 DTCs in New York City (1994-1996), 3 DTCs in Newark (1994-1997), and 3 DTCs in Seattle (1994-1997). HIV-1 positive specimens were re-tested using a less sensitive modification of the 3A11 EIA that becomes reactive approximately 129 days after a positive Western Blot. RBIS - Incidence was estimated by seroconversion among clients who consented to multiple HIV counseling and testing sessions while in treatment. Results: Among IDUs entering DTCs, HIV prevalence was 34% in New York (n=3,613), 25% in Newark (n=1,352), and 1% in Seattle (n=2,642). Using the STARHS method, 1,391 HIV positive specimens were tested, and 29 specimens were identified as recently infected. Annualized incidence estimates (adjusted for missing HIV+ specimens) were 2.5% in New York, 2.6% in Newark, and 0.3% in Seattle. Incidence estimates from RBIS among IDUs in treatment were 1.3% in New York, 0.9% in Newark, and 0.1% in Seattle. Conclusions: STARHS demonstrated higher incidence estimates than RBIS methodology, possibly indicating that incidence may be lower in the self-selected population that tests frequently. STARHS is an accurate, economical, and feasible method for estimating HIV incidence.

Learning Objectives: At the end of this presentation, the participant will be able to:

  1. understand a new testing method (STARHS) that uses only a single blood specimen to identify recent HIV seroconverters,
  2. recognize potential applications of the STARHS method to estimate HIV incidence in high-risk populations.

Keywords: HIV/AIDS, Drug Injectors

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: none
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

The 128th Annual Meeting of APHA