Home Testing To Detect Human Immunodeficiency Virus: Boon or Bane?

PIN50 NON-SEXUAL RISK BEHAVIORS ARE ASSOCIATED WITH INCREASED ODDS OF HIV TESTING: RESULTS FROM THE 2017 BRFSS

To determine whether implementation of provider-initiated human immunodeficiency virus (HIV) counseling would increase the proportion of tuberculosis (TB) patients who received HIV counseling and testing. Cluster-randomized trial with clinic as the unit of randomization. Twenty, medium-sized primary care TB clinics in the Nelson Mandela Metropolitan Municipality, Port Elizabeth, Eastern Cape Province, South Africa. A total of 754 adults (18 years and older) newly registered as TB patients in the 20 study clinics. Implementation of provider-initiated HIV counseling and testing. Percentage of TB patients HIV counseled and tested. SECONDARY: Percentage of patients with HIV test positive, and percentage of those who received cotrimoxazole and who were referred for HIV care. : A total of 754 adults newly registered as TB patients were enrolled. In clinics randomly assigned to implement provider-initiated HIV counseling and testing, 20.7% (73/352) patients were counseled versus 7.7% (31/402) in the control clinics (P = 0.011), and 20.2% (n = 71) versus 6.5% (n = 26) underwent HIV testing (P = 0.009). Of those patients counseled, 97% in the intervention clinics accepted testing versus 79% in control clinics (P = 0.12). The proportion of patients identified as HIV infected in intervention clinics was 8.5% versus 2.5% in control clinics (P = 0.044). Fewer than 40% of patients with a positive HIV test were prescribed cotrimoxazole or referred for HIV care in either study arm. Provider-initiated HIV counseling significantly increased the proportion of adult TB patients who received HIV counseling and testing, but the magnitude of the effect was small. Additional interventions to optimize HIV testing for TB patients urgently need to be evaluated.

Bundling human immunodeficiency virus (HIV) testing with tests for other infectious diseases such as hepatitis C, syphilis, or gonorrhea has been proposed as a method to recruit at-risk individuals into HIV testing. The objectives of this study were to determine (1) the types of at-risk clients who choose the rapid vs. standard HIV test when bundled with hepatitis and sexually transmitted infection (STI) tests, and (2) whether clients receiving a rapid HIV test are more likely to return on time for hepatitis and STI test results. We recruited individuals from drug treatment programs, methadone maintenance programs, needle-exchange programs, a community-based agency serving the gay and lesbian community, and the Center for Behavioral Research and Services' office-based testing facility at California State University, Long Beach from January 2005 through November 2007. A total of 2,031 clients from a multiple morbidities testing program in Long Beach, California, were tested between January 2005 and November 2007. For clients receiving hepatitis and STI testing, the majority chose the standard HIV test. Clients who received a rapid HIV test returned in significantly fewer days than clients who received a standard HIV test. Injection drug users and sex traders were more likely to choose the standard HIV test and more likely to fail to return for test results on time. The rapid HIV test, in conjunction with hepatitis and STI tests, results in clients being more likely to return on time for hepatitis and STI results. Public health efforts should focus on acquainting high-risk clients with rapid HIV testing.

Introduction/Aim: In Belgrade, syphilis and human immunodeficiency virus (HIV) infection most often occur among men who have sex with men who are often stigmatized and discriminated and hesitate to come to health institutions for testing for these diseases. The aim of this study was to assess prevalence of syphilis and HIV infection among men who have sex with men who were tested in the "check-point" center of the association "Potent" in Belgrade. Methods: This cross-sectional study included 993 participants tested for HIV and 860 participans tested for syphilis by rapid screening tests HEXAGON SYPHILIS and HEXAGON HIV. The results of rapid HIV tests were confirmed by a positive Western-Blot test at the Infectious Diseases Clinic of the Clinical Center of Serbia, and for syphilis by positive serological tests (VDRL - Venereal Disease Research Laboratory and TPHA - Treponema Pallidum Haemagglutination Assay) at the City Institute for Skin and Venereal Diseases in Belgrade. Proportions, percentages and the ch2 test were used in the statistical analysis of the data. Results: A positive test for HIV was recorded in 11 (1.1%), and a positive test for syphilis in 34 participants (3.9%). The youngest newly diagnosed HIV positive case was 22 years old and the oldest 46 years old, while the youngest case with a positive test for syphilis was 19 years old and the oldest 68. Conclusion: Strategies for testing for syphilis and HIV among men who have sex with men should be diverse, including community testing conducted by non-government organization in cooperation with health facilities.

In Brief Objective To determine if awareness of methods to reduce vertical transmission of human immunodeficiency virus (HIV) is associated with HIV test acceptance and to clarify patients' attitudes toward routine versus elective prenatal HIV testing. Methods In a cross-sectional study, 247 antenatal patients were surveyed regarding HIV knowledge, self-perceived HIV risk, and willingness to learn a positive test result. This information, along with demographic and risk factor data, was related to HIV test acceptance. Patients also indicated their attitudes toward routine versus elective prenatal testing for HIV and other common prenatal screening tests. Results Seventy-two percent of antenatal patients accepted HIV testing. Test acceptance was not associated with the presence of risk factors, self-perceived HIV risk, or demographic factors, including race and ethnicity. Test acceptance was associated positively with patients' knowledge of a medical intervention to reduce vertical transmission and their willingness to learn a positive HIV test result. Only 24% of patients knew that the risk of vertical transmission could be reduced using medication. Sixty-nine percent of patients said that prenatal HIV testing should be routine, whereas 27% said that it should be done only after specific written consent. As a group, our patients viewed HIV screening no differently from screening for other infections in pregnancy. Conclusion Interventions aimed at increasing HIV testing rates among pregnant women should focus on educating patients about vertical transmission reduction and promising new therapies for HIV infection. Proponents of elective testing should re-evaluate the assumption that patients view HIV testing differently from other prenatal tests for which separate written consent is not required. Most pregnant women will accept testing for human immunodeficiency virus if they know that a medication exists to reduce transmission to their infants, but few are aware of this intervention.

Optimal blood donation screening annotation.

HIV Testing Among At-Risk Adolescents and Young Adults: A Prospective Analysis of a Community Sample

To determine youth preferences for Food and Drug Administration (FDA)-approved and investigational human immunodeficiency virus (HIV) antibody collection and testing methods before and after subjects learned of test result response times; to determine how influential test result response times are on participants' preferences. After health educators explained and demonstrated 6 different HIV antibody collection and testing strategies (3 saliva, 1 urine, and 2 fingerstick methods), participants completed a confidential survey about test method preference and tried the different testing methods. The participants had an opportunity to re-rank their test method preference after learning about each test's result response time. Health education sessions in both clinical and community settings. Youths aged 12 to 24 years. An oral collection device with a rapid saliva test was the most highly preferred test method. The preference for this method and the rapid response test methods via fingerstick procedures improved significantly after subjects learned of the rapid result response time, while the other methods were given significantly lower preference rankings after subjects learned of the longer result response times. Shifts in preference rankings were not related to sex, age, ethnic group, experience with HIV testing, or practice of risk behaviors. Our research supports the use of noninvasive and rapid HIV testing methods with rapid response times for adolescents to assist in the early identification of HIV status, while offering HIV prevention opportunities and immediate linkage to care.

Based on US. Centers for Disease Control and Prevention recommendations, New York State enacted legislation in 2010 requiring healthcare providers to offer non-targeted human immunodeficiency virus (HIV) testing to all patients aged 13-64. Three New York City adult emergency departments implemented an electronic alert that required clinicians to document whether an HIV test was offered before discharging a patient. The purpose of this study was to assess the impact of the electronic alert on HIV testing rates and diagnosis of HIV positive individuals. During the pre-intervention period (2.5-4 months), an electronic "HIV Testing" order set was available for clinicians to order a test or document a reason for not offering the test (e.g., patient is not conscious). An electronic alert was then added to enforce completion of the order set, effectively preventing ED discharge until an HIV test was offered to the patient. We analyzed data from 79,786 visits, measuring HIV testing and detection rates during the pre-intervention period and during the six months following the implementation of the alert. The percentage of visits where an HIV test was performed increased from 5.4% in the preintervention period to 8.7% (p<0.001) after the electronic alert. After the implementation of the electronic alert, there was a 61% increase in HIV tests performed per visit. However, the percentage of patients testing positive per total patients-tested was slightly lower in the post-intervention group than the pre-intervention group (0.48% vs. 0.55%), but this was not significant. The number of patients-testing positive per total-patient visit was higher in the post-intervention group (0.04% vs. 0.03%). An electronic alert which enforced non-targeted screening was effective at increasing HIV testing rates but did not significantly increase the detection of persons living with HIV. The impact of this electronic alert on healthcare costs and quality of care merits further examination.

Impact of the COVID-19 pandemic on an emergency department-based opt-out HIV screening program in a South Florida hospital: An interrupted time series analysis, July 2018-March 2021

To evaluate the accuracy and costs of newer rapid human immunodeficiency virus (HIV) antibody tests in primary health care settings in rural Zambia. Three rural hospitals participated in this study. During a baseline assessment period, HIV testing practices were recorded on 250 consecutive clients at each hospital. Baseline evaluation was compared with 250 subsequent consecutive clients tested using a testing algorithm consisting of an initial screening HIV Dipstick test (McDonald Scientific [PVT] Limited, Harare, Zimbabwe) followed by confirmatory testing of all reactive specimens using the HIV Capillus test (Cambridge Diagnostics, Galway, Ireland), in conformity with World Health Organization HIV testing recommendations. Quality control was performed at a national university teaching hospital laboratory. A total of 1,500 clients was entered, with an HIV seropositivity rate of 53.2%. Most HIV testing was performed on patients with signs and symptoms suggestive of HIV infection. Same-day results were provided for only 16%. The HIV Dipstick testing algorithm sensitivity was 96.9%, and specificity was 98.0%. Counselor dissatisfaction was greater with the Dipstick algorithm as a result of 5.3% discordant results. Use of the HIV Dipstick testing algorithm cost between US $3.00 and US $3.80 per client tested. The accuracy of HIV testing in unsophisticated rural laboratories in Zambia is acceptable. Although HIV Dipstick testing algorithm costs were relatively high for a developing country, this HIV testing procedure is currently the most economical method available in Zambia. Accurate, less costly HIV testing algorithms are still needed.

Human immunodeficiency virus (HIV) continues to be a significant public health concern for adolescents and young adults. Since 2006, the Centers for Disease Control and Prevention has recommended more aggressive routine screening for HIV for patients presenting to the emergency department (ED). Our objectives were to design and validate a survey of physician barriers toward the use of rapid HIV testing in the pediatric ED and then to use this validated tool to conduct a national survey of pediatric emergency practitioners' attitudes toward rapid HIV testing in the ED. Survey design and initial validation steps were conducted with a panel of health care practitioners familiar to HIV testing. Several variables were identified as possible barriers toward rapid HIV testing. The survey was sent via electronic software to a national sample of pediatric emergency practitioners over 2 listservs. The previously identified variables were evaluated by factor analysis for internal consistency and homogeneity, and confirmatory factor analysis was conducted via promax and varimax rotation. All factor analyses were conducted using Stata software. Once the validation was complete, the surveys were sent to groups of pediatric emergency practitioners who had previously identified as having rapid HIV testing available in their EDs. Standard descriptive statistics were used, and group differences were evaluated with t test and χ(2) test. Four factors were identified during the validation process as being the most important barriers for rapid HIV testing in the pediatric ED: self efficacy, familiarity, external barriers, and a previously unidentified factor, which we interpreted as related to barriers to the specific environment of one's own ED. A total of 80 participants returned the final, validated survey. The participants came from 9 different pediatric emergency medicine groups (5 in areas of low rates of HIV infection, 4 in areas of high rates of HIV infection). Self-reported rates of testing were not different based on HIV infection rate in the community or the respondent's level of training. High testing was more common when a guideline was reported (39%) than when it was not (13.3%; difference, 25.7%; 95% confidence interval, 2.9%-48.5%). Of the 4 factors identified, we found statistically significant differences in scores on all 4 factors between high versus low testers, with high testers disagreeing more strongly with the various barrier questions proposed. We found no difference in the factor scores between areas of high versus low HIV infection rates. Our results suggest that several factors related to perceived provider barriers are associated with rates of HIV testing in the ED and that personal factors (eg, level of training) and community HIV prevalence were not associated with rates of testing. Our results confirm what has been speculated by numerous authors and provide data to inform efforts to improve compliance with national recommendations for increased testing.

Laboratory Industry Perspectives on the Role of Self-Collection and Self-Testing in Remote Care for Sexually Transmitted Infections: How Do We Bring These Services to Scale?

This study explored the feasibility and acceptability of a bundled human papillomavirus (HPV) vaccine and human immunodeficiency virus (HIV) testing program for young gay and bisexual men (YGBM). YGBM aged 18-26 years (N=55) were recruited to receive HPV vaccine with optional HIV testing and personalized counseling. Sexual risk behaviors and knowledge were assessed at three study visits. By visit 3, about 98% had received an HIV test with HPV vaccination; 59% received repeat HIV testing. Findings support the bundling of HPV vaccination with HIV testing among YGBM. Future directions include examining the scalability of integrating clinic-based HIV and HPV healthcare services.

To the Editor—We appreciate the correspondence in this issue of the Journal by Jones et al and Laperche et al evaluating the performance of the Alere Determine HIV-1/2 Ag/Ab Combo test (Combo point-of-care test [POCT]) for the detection of antibodies for established human immunodeficiency virus (HIV) infection and p24 antigen for acute HIV infection (AHI) [1, 2]. We believe that the earliest stages of HIV infection, including AHI, are critical for both individual health and HIV prevention. During AHI, establishment of latency currently renders HIV infection incurable. Persons with AHI also have high viral loads, making them highly contagious for a brief period. AHI therefore represents an important time for intervention [3]. Identification of subjects with AHI is critical, yet challenging. Since persons are antibody-negative during AHI, HIV rapid tests, which detect HIV antibodies, cannot detect AHI. AHI can be detected only with diagnostics capable of identifying HIV RNA, DNA or p24 antigen. To date, most of these diagnostics have been laboratory-based. In a recent issue of the Journal, we evaluated the Combo POCT, a test designed to concomitantly detect HIV antibodies and p24 antigen in separate reading frames at the point of care [4]. Our study was conducted among persons attending a sexually transmitted infection clinic and an HIV testing and counseling center in Lilongwe, Malawi. We found that the antibody portion of the test had excellent sensitivity and specificity for detecting established HIV infection. However, the antigen portion of the test had zero sensitivity and inadequate specificity for detecting AHI. The antigen portion of the test was unable to identify any of the 8 persons with true AHI, and it falsely classified 6 HIV-uninfected persons as having AHI. Such incorrect results could cause considerable mental anguish, confusion, and cost. Jones et al report similar findings among high-risk persons in the United Kingdom [1]. The antibody portion of the Combo POCT had excellent sensitivity and specificity, but the antigen portion of the test had poor sensitivity and specificity. It did not identify the 2 persons with AHI, and it incorrectly classified 2 HIV-uninfected and 1 antibody-positive person as having AHI. They also noted several invalid tests and implementation challenges owing to a narrow reading interval. Laperche et al assess the sensitivity of the Combo POCT at different p24 concentrations and among different clades in archived plasma and stored supernatants [2]. Even in these laboratory settings, the Combo POCT was unable to detect p24 consistently, especially with non-B subtypes. Although laboratory testing can be an important early step for gauging when a test may or may not perform adequately, it simply cannot replace field testing, which is required to determine ultimate utility. This is especially important for a test like the Combo POCT, which is designed to be used at the point of care on finger-stick whole blood. Laperche et al note the difficulty of field testing for AHI. However, we and others have demonstrated the feasibility of this approach. We have reported elsewhere that AHI can be detected routinely in the sexually transmitted infection setting where we conducted our analysis [5], allowing us to conduct ongoing studies related to this stage of HIV disease [6–7]. Although the performance of the antigen portion of the Combo POCT has been disappointing, the goal of identifying persons during AHI is important [8]. Investigators and industry should work together toward designing sensitive and specific diagnostics that can detect AHI at the point of care. These diagnostics must then be field tested before clinical use, regardless of the degree of difficulty involved.