HIV Testing. Susan Tusher, LMSW Program Coordinator The Kansas AIDS Education and Training Center

Transcription

1 HIV Testing Susan Tusher, LMSW Program Coordinator The Kansas AIDS Education and Training Center

2 The Number of Persons in the US Living with HIV Continues to Increase Over 1 Million people are estimated to be living with HIV in the US. Of those, 280,000 (25%) are unaware of their serostatus E-2 1 December 2002

3 Awareness of Serostatus Among People with HIV and Estimates of Transmission ~25% Unaware of Infection Accounting for: ~54% of New Infections ~75% Aware of Infection Marks, et al AIDS 2006;20: ~46% of New Infections People Living with HIV/AIDS: 1,039,000-1,185, E-3 1 December 2002 New Sexual Infections Each Year: ~32,000

4 Late HIV Testing is Common Supplement to HIV/AIDS Surveillance, Among 4,127 persons with AIDS*, 45% were first diagnosed HIV-positive within 12 months of AIDS diagnosis ( late testers ) Late testers, compared to those tested early (>5 yrs before AIDS diagnosis) were more likely to be: Younger (18-29 yrs) Heterosexual Less educated African American or Hispanic E-4 1 December 2002 *16 states MMWR June 27, 2003

5 Time to Take Another Approach E-5 1 December 2002

6 Reasons for Testing: late versus early testers 100% 80% Supplement to HIV/AIDS Surveillance, Late (Tested < 1 yr before AIDS dx) Early (Tested >5 yrs before AIDS dx) 60% 40% 20% 0% Illness Self/partner at risk Wanted to know Routine check up Required Other

7 Late Access to Care Costs Patients with CD4 <200 More likely to have a complication of AIDS More likely to have side effects from treatment Less likely to achieve an undetectable viral load CD4 Stratum (cells/ml 3 ) <50 57, , ,848 >500 21,869 Annual Cost ($) Source: Egger, Lancet, 2002; Phillips, AIDS, 2004; Gebo,, 13th CROI,, 2005

8 More is Better Earlier access to available medications resulting in increased length of life Those who know they are positive tend to take more precautions to protect others On a population wide basis, such screening could reduce spread because medications suppress viral load and reduce the chance of transmission

9 Revised Recommendations for HIV Screening in Health-Care Settings in the U.S. September, 2006

10 New Guidelines for HIV Screening HIV screening is recommended in all health care settings, after notifying the patient that testing will be done. Separate written consent for HIV testing is not required. Prevention counseling is not recommended as part of routine HIV screening programs in health care settings. HIV screening should be included in the routine panel of prenatal screening tests for all pregnant women.

11 The CDC recommends that HIV screening be a routine part of health care for all: Individuals in the U.S. between the ages of 13 and 64 Patients receiving care for tuberculosis (TB) Patients in care for other sexually transmitted diseases (STDs) Women who are considering conception and pregnancy Women who are pregnant Women in delivery who have undocumented HIV status at the onset of labor Infants born to mothers with undocumented HIV status.

12 CDC Recommendation for HIV Screening Opt-out HIV screening and HIV diagnostic testing should be a part of routine clinical care in all healthcare settings. This information is based on: Centers for Disease Control and Prevention (CDC). (2006, September 22). Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. Information take from: September 22, 2006

13 Routine Testing Routine one-time testing of everyone would cut new infections each year by just over 20% Every HIV-infected patient identified would gain an average of 1 ½ years of life. Source: study by researchers at Duke and Stanford Universities and the Veterans Affairs Palo Alto Health Care System

14 Health-care settings include: emergency and urgent care sites primary care settings corrections health care substance use treatment services outpatient clinics inpatient services in all public and private sectors. Recommendations are based on best practices and meant to comply with ethical principles of informed consent. Recommendations do not take into account state, local, or institutional regulations. Providers should be aware of HIV statues or other regulations in the states and facilities in which they work.

15 Prenatal HIV Screening Based on information presented in the MMWR both opt-out and prenatal maternal screening AND mandatory newborn screening achieve higher maternal screening rates than opt-in prenatal screening. CDC recommends that clinicians routinely screen all pregnant women for HIV infection using an opt-out approach

16 Number of cases

17 HIV Status Known at Delivery % 80% % 40% % 0% Jun- 05 Jul-05 Aug- 05 Sep- 05 Oct- 05 Nov- 05 Dec- 05 Jan- 06 Feb- 06 Mar- 06 Apr- 06 May- 06 Jun- 06 Jul-06 Aug- 06 Sep- 06 Oct- 06 Nov- 06 Dec- 06 Known E-17 1 December HIV 2002Status Unknown HIV Status

18 100% 110 HIV Status Known at Deliver % % 40% Unknown HIV Status Known HIV Status % 0% Jan-07 Feb-07 Mar-07 Apr-07 May-07 Jun-07 Jul-07 Aug-07 Sep-07 Oct-07 Nov-07 Dec E-18 1 December 2002

19 Rapid HIV Testing: The Waive of the Future

20 Available HIV Rapid Tests in the United States Six rapid HIV tests approved by the U.S. Food and Drug Administration (FDA) are commercially available for use in the United States (listed in chronological order of their FDA approval dates): OraQuick Rapid HIV 1 / 2 Antibody Test Reveal G2 Rapid HIV - 1 Antibody Test Uni-Gold Recombigen HIV Test - 1 Multispot HIV-1 / HIV-2 Rapid Test Clearview HIV 1 / 2 Stat Pak Clearview Complete HIV 1 / 2 Tests currently being used in Kansas

21 OraQuick Advance The only rapid test approved for use with oral fluid as well as whole blood and plasma The only rapid test approved for detection of both HIV-1 and HIV-2

22 Insert loop into vial and stir

23 Reactive Control Positive HIV-1/2 Positive Negative Read results

24 UniGold Tests for HIV-1 Less expensive then OraSure brand - $11.00 per test Different process utilizes a pipette to collect whole blood and a dropper bottle of washing agent and a different process

25 Uni-Gold Recombigen HIV Assay Procedure Holding the pipette vertically over the sample port, add one (1) drop of sample (approx. 50µl) carefully and allow to absorb. Ensure air bubbles are not introduced into the sample port.

26 Uni-Gold Recombigen HIV Assay Procedure Add four drops of Wash Solution.

27 Interpretation Reactive Test Result Non-Reactive Test Result

28 When Is A Rapid Test Indicated? Obstetric admissions Healthcare worker occupational exposures Urgent care clinics and Emergency departments Public health settings Developing countries The primary Care office

29 How It Really Works E-29 1 December 2002