185371 Impact of a rapid HIV testing algorithm on receipt of HIV testing results and referral to medical care

Tuesday, October 28, 2008: 2:40 PM

Jacqueline Rurangirwa, MPH , Office of AIDS Programs and Policy, County of Los Angeles, Department of Public Health, Los Angeles, CA
Thomas Knoble, MSW , AIDS Office, HIV Prevention Section, San Francisco Department of Public Health, San Francisco, CA
Mike Janson, MPH , Office of AIDS Programs and Policy, County of Los Angeles, Department of Public Health, Los Angeles, CA
Peter R. Kerndt, MD, MPH , Sexually Transmitted Diseases Program, County of Los Angeles, Department of Public Health, Los Angeles, CA
Teri Dowling, MA, MPH , AIDS Office, HIV Prevention Section, San Francisco Department of Public Health, San Francisco, CA
Grant Colfax, MD , AIDS Office, HIV Prevention Section, San Francisco Department of Public Health, San Francisco, CA
Jan B. King, MD, MPH , Office of AIDS Programs and Policy, Los Angeles Department of Public Health, Los Angeles, CA
     
Issue: With rapid HIV testing, many clients who test preliminary-positive fail to return for confirmatory results. Use of a rapid HIV testing algorithm (RTA) would eliminate the need for off-site confirmatory testing and reduce the number of clients not receiving confirmed results. The FDA permits use of rapid tests in multi-test algorithms; however, no specific guidance for their use in a RTA in point-of-care (POC) settings currently exists.

Description: In Los Angeles (LA) and San Francisco (SF,) we evaluated the impact and feasibility of using a RTA with up to three different HIV rapid tests in nine publicly funded POC settings, compared with 23 sites conducting standard rapid HIV testing.

Lessons Learned: From Aug-Nov 2007, of 3,474 clients tested, 48 (1.38%) had reactive results on 2 tests; all were referred to care on the same day. Nine (0.26%) false-positive results were also resolved on the same day by RTA. At non-RTA sites 6,133 clients were tested; 127 (2.07%) had a preliminary-positive result. Forty-eight (37.8%) of these received their confirmatory results and were referred to care within a mean of 14 days in LA and 7.6 days in SF.

Recommendations: Using a RTA, all newly identified HIV infections were referred into HIV medical care the same day; those with a false-positive test result were also resolved at the same visit. Preliminary results suggest using a RTA in POC settings allows more persons with newly identified HIV infection to be referred into care, with fewer lost to follow-up.

Learning Objectives:
By the end of the session participants will be able to: 1) Describe advantages of implementing a rapid HIV testing algorithm in POC settings. 2) Assess the impact of implementing a rapid HIV testing algorithm in POC settings in Los Angeles and San Francisco. 3) Discuss the likelihood of implementing rapid HIV testing algorithms in other HIV testing settings throughout the US.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Project Director for the HIV Rapid Testing Algorithm(RTA) study implemented in Los Angeles, CA. My responsibilities and activities consist of: • Overseeing the development of IRB protocol as the Los Angeles grantee team lead in conjunction with the other grantee and CDC project officer. • Supervise project team activities. • Day-to-day management and coordination of the project at all sites. • Liaison for the grant between CDC and Office of AIDS Programs and Policy.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

See more of: Learning from the Rest of the World: Development and Implementation of Rapid Test Algorithms for Point-of-Care HIV Testing in the United States
See more of: HIV/AIDS