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The application of existing and emerging testing technologies to more rapidly detect HIV infection among high-risk populations
Presented by Kevin Roe (United States).
K. Roe1, D. Gluth1, S. Gibson1, C. Hall1, T. Ryan1, J. Auerbach2, S. Facente3
1San Francisco AIDS Foundation, Magnet, San Francisco, United States, 2San Francisco AIDS Foundation, Science & Public Policy, San Francisco, United States, 3San Francisco Department of Public Health, AIDS Office, San Francisco, United States
Background: Rates of new HIV infections in San Francisco disproportionately affect MSM, with high incidence (2%) and prevalence (27%) rates. Individuals with acute HIV infection (AHI) account annually for an estimated 25% of new infection transmissions. Given limitations of existing testing technology and the need to more rapidly clarify test validity, new applications of existing and emerging HIV testing technologies are required to provide more timely and accurate infection verification -- including AHI-- to individuals in high incidence and prevalence settings.
Methods: Magnet, a program of the SF AIDS Foundation, in collaboration with the local health department and researchers, designed a testing algorithm to maximize existing and emerging technologies for use in the community setting with high-risk populations. A matrix of oral fluid and blood-based rapid antibody tests provides accelerated serostatus verification. Using a risk-based model, risk assessment and counseling information triangulates to identify individuals at greatest risk for AHI and eligible for RNA testing, capable of detecting infection within 2-4 weeks after exposure.
Results: Utilization of the oral fluid/blood matrix has accelerated infection verification from 7 days to 45 minutes. In 2007 and 2008, a total of 5,294 rapid oral fluid antibody tests were conducted with 95 (1.8%) confirmed positive in that time frame. RNA testing further detected 9 (1.7%) cases in acute infection that would not have been detected using antibody testing.
Conclusions: Health care and prevention service providers are looking for enhanced rapid testing technologies to screen for AHI. New testing technologies must continue to be explored and advances quickly adapted to reach those at greatest risk in practical and community-relevant ways, in a variety of settings. Lessons learned at Magnet are instructive for the application of enhanced HIV testing and screening techniques in other high incidence and prevalence populations.
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