Robert Wood Johnson Medical School. April 28, 2014

Transcription

1 Robert Wood Johnson Medical School April 28, 2014

2 Joanne Corbo, MBA HIV Program Manager

3 Website for NJ HIV Rapid Testing Support: njhiv.org

4 One Time Events Requests should be sent 10 business days in advance (No exceptions) Must use current form (electronic version on NJ HIV.org) Send to Sonya Thompson/copy to Joanne Corbo Approvals done by Sonya/PMO based on strict criteria for target population/prevalence (Criteria: zip code etc.) Results for One Day Events must be sent to Sonya Thompson/copy to Joanne Corbo within three business days of the event (electronic version on NJ HIV.org)

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8 One-Day Event Results Report Submit one form per event within three business days of event Date of Event: Sponsoring Agency: Testing Agency (if different than sponsoring agency): Zipcode of Testing location: Target # # Population Positive Negative TOTAL 0 0 * General Population is any non targeted group Please complete the entire form. Totals will automatically add for you. "SAVE AS" naming the file with your agency name and date of event. to Joanne Corbo at corbojo@rwjmc.rutgers.edu and Sonya Thompson at sonya.thompson@doh.state.nj.us within three business days.

9 Test logs: RWJ test logs due the 10 th of the month May also be sent as they are completed Please make sure logs are complete Site Number, Contact Information, shipment number Test information complete: Pos, Neg, Temperature, Start Time End Time, Operator Initials If doing second test for another site indicate second test and site number of first site Fax to or

10 NJHIV Positive Tracking Form Use new form included in packet (available on NJ HIV.org) Must be sent in as completed to RWJ Fax to or

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12 Discordant work up/ procedure: If second rapid or confirmatory does not match first rapid the result is discordant Draw blood for work up: Two white top tubes (must be spun down and frozen upside down) One serum separator (must be spun down and refrigerated) You must report all discordant results to RWJ Call Leave a message with contact information so RWJ pick up samples and process.

13 RWJ License renewals: License renewals sent with a checklist Coordinator must sign checklist to indicate all items necessary for regulatory compliance are in place at the site Send copy of standing order indicating it has reviewed and is current must be included Copy of standing order template included in packet (available on NJ HIV.org)

14 Checklist for License Renewal: Site Name We have the current signed RWJ NJ Rapid HIV Testing Support Program Policy Manual available at our testing location. We are using the current signed Exposure Control Plan provided in the RWJ NJ Rapid HIV Testing Support Program Policy Manual. We have a current signed Exposure Control Plan available at our testing location if we are not using the plan provided in the RWJ NJ Rapid HIV Testing Support Program Policy Manual. We have a copy of the standing order for performing Rapid HIV Testing signed by our current Medical Director or Authorized Physician at our testing location. The standing order has to be reviewed this year; We have documented that it is current and that the medical director (who signed it) has not changed. We have attached a copy of the standing order with our license application for RWJMS records. Signed by: Site Testing Coordinator

15 Standing Order Template To Whom It May Concern: This standing order shall constitute a request for rapid HIV testing for screenings performed at: Name of Testing Site: Address of Testing Site: In cases where a client receives a preliminary positive result using a rapid HIV test, this authorizes: HIV Western Blot and/or a second Rapid HIV test (for all preliminary positives); and follow-up testing as appropriate to the clinical setting which may include: Additional HIV serology HIV nucleic acid testing Signature Print Name Medical Director

16 Revised Frequently called Number List

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18 Updated RWJ Rapid HIV Support Contact List

19 NJ HV > Grant from Division of HIV STD & TB Services Linda Berezny, RN PMO Dept. of Pathology & Lab Medicine Robert Wood Johnson Medical School Evan Cadoff, MD Professor & Chairman Eugene Martin, Ph.D. Professor Gratian Salaru, MD Asst. Professor Joanne Corbo, MBA, MT Program Manager TECHNICAL Latasha Adams, MT Moeen Ahmed, MT Claudia Carron, RN Aida Gilanchi, MT Franchesca Jackson, BS Jaclyn Kollinger, MT Nisha Patel, MT ADMINISTRATIVE Lisa May Karen Williams

20 RWJ Sites: African American Office of Gay Concerns Atlantic City Health Department AtlantiCare Mission Health (Atlantic City Corrections) Bergen County Health Department Buddies of NJ Burlington County Health Department Camden AHEC Camden County Health Departments Catholic Charities (Union County Jail and Hudson County Jail) Checkmate, Inc City of Trenton City of Vineland Complete Health Care, Inc. Cumberland County Health Department Dooley House East Orange Health Department Eric B. Chandler Health Center FamCare Hamilton Township STD Clinic Henry J. Austin Health Center Hispanic Family Center HiTops Inc Horizon Health Hunterdon Health Department Hyacinth Foundation Iris House John Brooks Recovery JSAS Kean University Kennedy Health La Casa Don Pedro Liberation in Truth Newark STD Clinic New Horizon Health Center NJCRI NJ React North Hudson Community Action Corporation(9 sites) Oasis Drop In Center Ocean County Health Department Ocean Health Initiatives Paterson Department of Health Proceed Robert Wood Johnson Medical School Saint James Social Services Salem County Health Middlesex County Public Health Department NAP Newark NAP Trenton Neighborhood Health Newark Community Health Center Department South Jersey AIDS Alliance (OASIS) Visiting Nurse Association of Asbury Park Well of Hope William Paterson University Woodbridge Department of Health

21 Non-RWJ Sites: Asbury Park Community Health Center/Visiting Nurse Association Atlantic County Health Department Atlanti-Care Regional Medical Center Cape May County Health Department Cooper Medical Center-ER Cooper Medical Center-EIP/Camden County Jail Gloucester County Health department Greater Northern Jersey Planned Parenthood (10 Sites) Hoboken Family Planning- 3 sites Hurtado Health Center (Rutgers) Jersey City Medical Center JFK Medical Center Monmouth Regional Medical Center Morristown Memorial Hospital Newark Beth Israel Ocean County Family Planning Our Lady of Lourdes Planned Parenthood Metro Planned Parenthood of Central NJ Planned parenthood of Hamilton Planned Parenthood of East Orange Planned Parenthood of Mercer County Planned Parenthood of Southern NJ Raritan Bay Medical Center Saint John s Clinic Saint Joseph s Medical Center Saint Michaels Medical Center South Jersey Family Medicine ( 7 sites) Trinitas Hospital UMDNJ University Hospital ER & STOP University of Princeton Health Center (McCosh Infirmary) Women s Health & Counseling Center - Somerville Zufall Health

22 LEGEND Symbol Rapid Testing PROGRAM COMMUNITY BASED ORG. (CBO) MEDICAL CTR. ER MOBILE VAN JAILS NJ HIV May, 2009

23 Evan Cadoff, MD...Gene Martin, PhD Gratian Salaru, MD

24 Background Failure to return (2005) Missed Opportunities AHI in NJ NAAT data (2012) Category C Outcomes Expansion of RTA sites in NJ Training in RTA 4 th Generation Lab-based Testing Transition to 4 th Generation POC Testing Current limitations on 4 th Gen POC Testing Master plan ( ) Build out of 4 th Gen. POC Collaboration to facilitate linkage (Orthogonal confirmation of 4 th Gen. Lab-based Positives) Validation of istoc is there a way to objectively read rapid tests

25 Traditional: EIA or IF confirmed by traditional methods: HIV Western blot, IFA or Aptima Rapid Testing Options: 1. Rapid HIV Screen confirmed by traditional methods (Western blot, IFA) 2. Rapid HIV Screen confirmed by an orthogonal rapid tests Rapid-Rapid Model Clearview StatPak confirmed by Trinity Unigold Rapid-2-Rapid Model 1. Clearview StatPak is performed at Site #1 2. Transportation of Client to Site #2 (Typically a medical care entity) 3. Patient Navigator at Site #2 performs second orthogonal rapid 4. If HIV POS Laboratory Intake 3. Rapid Screen Alone Rare in NJ

26 IDSA SAN FRANCISCO

27 RWJ Sites: 97 Non RWJ Sites: 64 RWJ sites: Non RWJ site: Rapid HIV Testing NJ 60 Primary 24 satellites 13 mobile 64 sites including 12 ERS Testing volume Rapid-Rapid format: 2013 Tested 48,708 PRELIM POS 450 UG PERFORMED 439 UG CONFIRMED 426 From Inception 175,630 PRELIMINARY POS 1,503 PRESUMPTIVE POSITIVES 1,407

28 When compared against current rapid HIV tests, NAAT tells us we re missing between 6-8% of those infected when we screen for antibodies using one of the traditional rapid HIV tests Those with the highest risk of infecting others are the ones that are being missed!! The same issues with patient return and process completion occur with NAAT that occur with traditional testing!!! Solution: A test that picks up p24 Ag COULD identify a substantial proportion of the same population. A POCT device could increase the pickup without losing the ability to link patients to care. E.G. Martin et al. / Journal of Clinical Virology 58S (2013) e24 e28 28

29 Program Dates Description Maryland 6/06-3/08 North Carolina Los Angeles NEWARK, NJ Seattle King County Atlanta 11/02-10/03 2/04-4/04 2/10 to 1/12 9/03-1/05 10/02-1/04 HIV Ab neg adults seen at two STD clinics (6/06-- 3/08); multiple venues 7/07-3/08) HIV Ab neg persons in North Carolina seeking HIV testing at 110 publicly funded sites (n = 109,250) HIV Ab neg men seeking HIV testing at three STD clinics (n = 1712) HIV Ab neg adults receiving testing and counseling at two high risk urban hospitals in Newark, NJ HIV Ab neg MSM seeking HIV testing through Seattle-King County (n = 3525) 2202 adults receiving HIV testing and counseling at three high risk urban sites in Atlanta, Georgia Rapid Tested NAAT Tested AHI HIV Ab+ % HIV Ab + % Inc in Yield % Yield AHI 58, , % 0.41% 0.01% 108, % 3.95% 0.02% 1, % 7.14% 0.06% 12,390 6, % 6.90% 0.12% 3, % 6.17% 0.15% 2, % 6.06% 0.19% San Francisco 10/03-7/04 HIV Ab neg persons seeking HIV testing at San Francisco Municipal STD clinic (n = 3075) 2, % 10.48% 0.40% 29

30 Receipt of Pooled RNA Results Never Receive Results AHI Received Results Too Late for Optimal 42% Intervention Patel et al, CDC, Archives Int Med

31 Acute HIV Infection 31

32 Because individuals with AHI are highly infectious, have engaged in high risk behaviors, and are often unaware of their status they contribute substantially to the spread of HIV. Although the duration of AHI is short (typically 3-4 weeks), studies have consistently shown that ~ 50% of new HIV transmissions are caused by onward transmission within the first six months from an individual with AHI % develop symptoms of Acute HIV 50%-90% who have symptoms seek medical care Of those diagnosed with Acute HIV, 50% of patients seen at least 3 times before they are diagnosed SYMPTOMS - ACUTE HIV INFECTION Rash &/or fever(s), possibly in combination with: Malaise Loss of Appetite Weight loss Sore Throat Mouth Sores Joint Pain Muscle Pain Swollen lymph nodes Diarrhea Fatigue Night sweats Nausea/vomiting Headache Genital Sores LINKAGE AND TREATMENT OPPORTUNITY!

33 HIV RNA in Semen (Log 10 copies/ml) (1/30-1/200) Risk of Transmission Male to Female - Blue Reflects Genital Viral Burden Yellow Effect of ART Theoretical - Red (1/1000 1/10,000) (1/500-1/2000) (1/100-1/1000) Acute Infection Asymptomatic Infection HIV Progression AIDS Cohen and Pilcher, JID 191:1391, 2005

34 Point of Care - Based Laboratory - Based 34

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36 Substantially more sensitive than 3 rd Gen. HIV assays, earlier generation rapid HIV tests, and confirmatory assays Somewhat more sensitive than POC-based 4 th Gen. rapid HIV assay (Alere Determine Combo assay) They identify a significant proportion of acutely infected individuals (~90%) May be used in the diagnosis of HIV-1/HIV-2 infection in pediatric subjects (i.e., children as young as 2) and in pregnant woman Permit the identification of established HIV infections without the need to send-out for additional testing 36

37 Less sensitive than NAAT tests (individual or pooled); therefore MISSING some cases of AHI. Although the manufacturer claims it is ~ 35 minutes to an initial result, the reality is that in many laboratories the average time to an initial single result is much longer. Unfortunately, both FDA-approved lab-based assays report a single combined specimen result, so neither can differentiate initially between recent and established HIV infections. When used in conjunction with the new confirmatory algorithm they provide identification of individuals who have HIV antibodies, but require an additional NAAT test to rule in AHI. As of today, the only available 4 th gen. test that can on a preliminary basis identify recent infection is the standalone rapid test: The Determine Combo. 37

38 Architect package Insert: Fully-automated, random-access (no Control brackets) Stat capability HIV Combo assay: 29 minute time to first result >150 tests per hour on i2000sr >50 tests per hour on i1000sr Manutac et al. JCV. 58S (2013) e

39 Avg.: 57.7 min

40 4 th Generation HIV1/2 EIA Is it reproducible? If repeatedly reactive HIV-1/2 Differentiation Assay BIORAD MULTI-SPOT HIV + HIV-1 -/ HIV-2 - ANTIBODIES NEGATIVE or IND HIV-1 +/ HIV-2 HIV-1 antibodies detected Logistic delays? HIV-1 -/ HIV-2 + HIV-2 antibodies detected RNA Testing HIV-1 +/ HIV-2 + HIV antibodies detected Additonal Testing Required to rule out a dual infecton RNA + Acute HIV Infection RNA - NEGATIVE 40

41 Tests for the simultaneous and separate qualitative detection of free HIV-1 p24 antigen and antibodies to HIV-1 and HIV-2. Lot number Name of Test Patient Identification It is intended for use as a pointof-care test to aid in the diagnosis of infection with HIV-1 and HIV-2, including an acute HIV-1 infection, and may distinguish acute HIV-1 infection from established HIV-1 infection when the specimen is positive for HIV-1 p24 antigen and negative for anti-hiv-1 and anti- HIV-2 antibodies. Control Line Sample Pad p24 Antigen Result HIV Antibodies Result Highlights Alere Determine Ag/Ab Combo Alere Determine HIV-1/2 Ag/Ab Combo Package Insert Rev: /09 41

42 Seroconversion panels Determine HIV-1/2 (3 rd gen) Ab Day: Determine Combo (4 th gen) Ag Ab Day: Earlier detection Panel AS PRB943 (BBI, Seracare)

43 Seroconversion panels Determine HIV-1/2 Ab Nonreactive. Dismissed. Ab Determine Combo Ag Reactive. Presumably Recent infection. Ag Ab Day: 12 Panel AS PRB943 (BBI, Seracare)

44 Seroconversion panels: FDA approved assays 4 th Generation Lab Assays Days Before Western Blot positive * Modified from Silvina M, et al. Performance of the Alere DetermineTM HIV ½ Ag/Ab Combo Rapid Test with specimens from HIV-1 serocoverters from the US and HIV-2 Infected individuals from Ivory Coast. J Clin Virol 2013: Published Online 05 August DOI: /j.jcv

45 Order of sensitivity to acute HIV infection: Individual NAAT Aptima > Pooled NAAT >4 th Gen. Tests Lab-based 4 th Gen: Architect/Biorad >POCT based 4 th Gen: Determine Combo More than half of HIV transmission is thought to occur during the earliest phase of infection Weighing the potential benefit of slightly improved sensitivity versus the immediacy of the result is a decision that needs to be driven by a careful assessment of the circumstances involved in particular screening programs! 45

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47 Rapid-Rapid Monthly Test Volume TotalTest 48, Rapid-Rapid Test Volume 2.2% Percent Refuse Unigold Verification Percent of Prelim Positive Results not Verified by 5.3% Unigold Percent UG Verified Connected to Care on Same 62.9% Day 2.3% Percent UG Failed to Verify of UG Performed

48 GOAL: Simplify the process. Maximize linkage and re-engagement. More clients complete testing and are linked to care on the same day using an RTA. Average time to lab intake for HIV+ positives is < 2 business days 175,630 RTA Testing Volume SINCE INCEPTION 5.7% Percent Refuse Western blot 2.5% Percent Refuse Unigold Verification Percent of Prelim Positive Results not Verified 3.9% by Unigold 2013 New Pos Re-Engaged Already in Care Client Refused Denied Charity Care No Show Bus Days to Lab Intake 344 POS from Apr - Dec SUBTOTAL RTA POS Distribution 1% 9% 3% 6% New Pos 26% 55% Re-Engaged Already in Care Client Refused Denied Charity Care No Show

49 NJ Hospitals have been slow to adopt 4 th Gen. HIV Category C project encouraged the transition by supporting ED testing in 2013: St. Joseph s Medical Center (89% complete) Contract: 2000 tests To Date: 1782 tests, 7 Positives 0 AHI, 7 Established Infections, Several FP Architects Our Lady of Lourdes (80% complete) Renewed Contract: 3600 tests To Date: 2881 tests, 18 Positives 3 AHI, 9 Established Infections, 3 FP Architect, 3 FP StatPak Jersey Shore Univ. Medical Center (30%) Contract: 2400 To Date: 70 tests, 2 Positive 0 AHI

50 Increase RTA availability in NJ: - Added 11 facilities including 8 hospitals and 1 multi-facility FQHC - Currently RTA testing exceeds 48,000 tests per year at rapidrapid facilities - Expand the program to include additional Rapid-2-Rapid screening ONLY sites - Reduces QC costs at sites with relatively few positives Recruit Mod. Complex. Facilities to implement 4 th gen. POC testing 3 hospitals have agreed 2 additional facilities have agreed 1 site begun RWJMS Question: How to integrate 4 th gen. POC and lab-based? Consider using Determine Combo as an orthogonal confirmation expediting identification of AHI at hospitals

51 OVERALL GOAL APPROACH OUTCOMES Expand RTA by an additional 9 sites, currently performing Traditional HIV testing estimated to test 29,000/year 1. Approach Non-RWJ laboratory directors utilizing existing HIV site coordinators to gain entry and begin educational process with Bioanalytical Lab Directors 2. Encourage laboratory representation at various state planning meetings related to Linkage to Care and RTA testing. 3. Publish and Present information about RTA guidelines and Presumptive Positives 1. Eleven sites added: Monmouth Regional Med Ctr./Jersey Shore Medical Center Trinitas Hospital Camden County Jail Raritan Bay Medical Center Jersey City Medical Center St. Joseph's Our Lady of Lourdes City of Trenton UMDNJ/UH ER Newark Beth Israel North Hudson Community Action (Multi-site FQHC) Rapid-Rapid Testing 48,000 Navigator - 67 (R2R) conducted; 96% positive (4% discordant) and all +s (100%) enrolled in care 3. Ms. Corbo has joined the NJ HIV Planning Group, joined numerous collaborative meetings 4, Since 2005: Abstracts: posters 15 platform presentations papers 3 platform presentations

52 OVERALL GOAL APPROACH OUTCOMES Prepare to Implement Point-of- Care 4 th Generation Testing in the absence of CLIA WAIVER Prepare to transition existing Lab-based 4 th generation testing to POC-based 4 th generation tests Transition selected POC 2nd generation testing (StatPak) to POC-based 4 th gen. tests (Determine Combo) 1. Validate assay using available Performance Panels 2. Develop procedures, forms, training program 3. Identify method for Proficiency Testing 4. Set-up Pilot Site 1. Approach existing Lab-based 4 th gen. sites and their non- RWJ Bioanalytical Lab Directors regarding interest in licensing Determine prior to CLIA-Waiver 2. Consider using Determine Combo as an orthogonal confirmation expediting identification of AHI 1. Approach higher prevalence locations to transition initial HIV screen to Determine Combo 1. Assay performance validated 2. Procedures, forms and training program completed 3. Pilot site: RWJ 003 Site (Mod. Complexity) trained. Testing has begun. 1. Requests initiated to: Jersey Shore Medical Ctr. - Neptune Our Lady of Lourdes Camden St. Joseph s Med. Ctr. - Paterson 1. Requests accepted by: NJCRI Newark Complete Healthcare Neighborhood Health

53 Thanks! 53

54 Site Number Site Description MONTH Clients Tested by StatPak Prelim Positive UniGold Performed UniGold Confirmed UniGold Refusal Number of Discordant NOTES 6364 CTR Walk -IN Jan Emergency Room Jan Community 6587 Outreach Jan Lennard Clinic Jan

55 SITE Number IF R-2- R please indicate screeni ng SITE Number Date /9/ /15/ /27/ /27/ /29/ /30/ /8/ /16/ /22/ /29/ /15/14 Positive Client CTS Number NEW POS x X RE- ENGAGED x X X X ALREADY IN-Care Appt. Date 1/17/1 4 1/15/1 4 1/27/1 4 1/30/1 4 1/29/1 4 1/30/1 4 Appt. KEPT Bus Days to Lab Intake No Show Narrative Client couldn t link the same day because client didn t have any identification. Client stated it was lost; he had no insurance which meant he had to apply for charity care which requires I.D. Client returned on January 17 th with I.D. and was linked to care the same day. yes 5 yes 0 Yes 0 yes 3 Yes 0 Yes 0 Client was linked to care the same day. Client currently in care. Client was linked to care the same day. Client currently in care. Client stated he had to go out of town for a few days and when he returned on the 30 th he would commit to care. Client came in on the 30 th and was linked to care. Client was linked to care the same day. Client currently in care. Client was linked to care the same day. Client is currently in care. X 1/8/14 Yes 1 Client was linked to care the same day. Client is currently in care. X X 1/17/1 4 1/22/1 4 Yes 1 Client was linked to care on the 17 th the next business day and is currently in care. Yes 5 x No No - x 1/24/1 4 Yes 7 Client was linked to care the same day. Client is currently in care. Client refused linkage to care stated he wasn t interested. Patient Navigator will follow up with client. Client was a Rapid to Rapid referral from the Lennard Clinic. Although client was tested and referred from the Lennard Clinic on 1/15/14 he didn t come in for confirmatory testing until the 24 th. Client stated he couldn t stay to be linked to care on the 24 th and

56 GOAL: Simplify the process. Maximize linkage and re-engagement. More clients complete testing and are linked to care on the same day using an RTA. Average time to lab intake for HIV+ positives is < 2 business days 175,630 RTA Testing Volume SINCE INCEPTION 5.7% Percent Refuse Western blot 2.5% Percent Refuse Unigold Verification Percent of Prelim Positive Results not Verified by 3.9% Unigold 2013 (344 POS from Apr - Dec) New Pos Re- Engaged Already in Care Client Refused Denied Charity Care No Show Bus Days to Lab Intake SUBTOTAL % 2013 RTA POSITIVE Distribution 6% 9% 3% New Pos 26% 55% Re- Engaged

57 RWJ Sites: Non-RWJ Sites: African American Office of Gay Concerns Burlington County Health Department Atlantic City Health Department Camden AHEC AtlantiCare Mission Health (Atlantic City Corrections) Camden County Health Departments City of Trenton City of Vineland Complete Health Care, Inc. East Orange Health Department Hispanic Family Center Iris House Liberation in Truth Newark Community Health Center North Hudson Community Action Corporation(9 sites) Proceed Visiting Nurse Association of Asbury Park Eric B. Chandler Health Center FamCare Bergen County Health Department Catholic Charities (Union County Jail and Hudson County Jail) Cumberland County Health Department Hamilton Township STD Clinic HiTops Inc Horizon Health Hunterdon Health Department John Brooks Recovery Middlesex County Public Health Department Newark STD Clinic Oasis Drop In Center Robert Wood Johnson Medical School Well of Hope Buddies of NJ Checkmate, Inc Dooley House Henry J. Austin Health Center Hyacinth Foundation JSAS Kean University La Casa Don Pedro NAP Newark NAP Trenton Neighborhood Health New Horizon Health Center Ocean County Health Department Saint James Social Services William Paterson University NJCRI Ocean Health Initiatives Salem County Health Department NJ React Paterson Department of Health South Jersey AIDS Alliance (OASIS) in licensing process Asbury Park Community Health Center/Visiting Nurse Association Cooper Medical Center- EIP/Camden County Jail Jersey City Medical Center Ocean County Family Planning Planned Parenthood of East Orange Saint Joseph s Medical Center University of Princeton Health Center (McCosh Infirmary) Atlantic County Health Department Gloucester County Health department JFK Medical Center Our Lady of Lourdes Planned Parenthood of Mercer County Saint Michaels Medical Center Women s Health & Counseling Center - Somerville Atlanti-Care Regional Medical Center Greater Northern Jersey Planned Parenthood (10 Sites) Monmouth Regional Medical Center Planned Parenthood Metro Planned Parenthood of Southern NJ South Jersey Family Medicine ( 7 sites) Zufall Health Cape May County Health Department Hoboken Family Planning- 3 sites Morristown Memorial Hospital Planned Parenthood of Central NJ Raritan Bay Medical Center Trinitas Hospital Cooper Medical Center-ER Hurtado Health Center (Rutgers) Newark Beth Israel Planned parenthood of Hamilton Saint John s Clinic University Hospital - Newark ER & STOP

58 ARTICLES: Since Paul SM, Cadoff EM, and Martin E. Rapid Diagnostic Testing for HIV Clinical Implications. Clinical Virology and Infectious Disease Paul S, Cadoff E, and Martin E. Rapid Diagnostic Testing for HIV: Clinical Implications of a New Diagnostic Tool. New Jersey AIDSLine. 2005; 1: Paul S, Cadoff E, Martin E, Wolski M, Nichol L, Williams R, Harvey-Talbot M, Bruccoleri P, Maung A, Martin R, and Berezny L. Rapid HIV Testing in New Jersey Hospital Emergency Departments. New Jersey AIDSLine, 2005:2(1): Shah MB, Paul SM, Bishburg, E, and Martin EG. Update on HIV and Hepatitis C Virus Co-Infection. New Jersey AIDSLine. 2(2): 3-10, Gentz M, Paul SM and Martin EG. 2(4): 4-11, Hepatitis B and HIV Co-infection. New Jersey AIDSLine, 6. Jafa K, Patel P, MacKellar DA, Sullivan PS, Delaney KP, Sides TL, Newman AP, Paul SM, Cadoff EM, Martin EG, Keenan PA and Branson BM for the OraQuick Study Group. (2007) Investigation of False Positive Results with an Oral Fluid Rapid HIV-1/2 Antibody Test. PLoS ONE 2(1): e185. doi: /journal.pone Paul SM, Martin RM, Lin Y, Lu SE, Cadoff EM and Martin EG. Voluntary Rapid HIV Testing in Emergency Departments in New Jersey. Garden State Focus. 53(3): 23-25, November/December Cadoff EM, Salaru G, Marone R, Gaur S, Paul SM and Martin EG. Integrating Rapid HIV Testing in Emergency Care Improves HIV Detection. Point of Care. 6(3): 1-7, Martin, EG and MA Newton. Rapid HIV Testing. In Czech and Slovaks in an International and Global context: Proceedings of the 23 th SVU World Congress. Editors: M. Rechcigl, V. Papusck and M. Bauer. Univ. of S. Bohemia, 2008, Paul SM and Martin EG. HIV Test Recommendations, Assay Selection. ADVANCE for Administrators of the Laboratory, 17(7): 86-92, Paul, SM and Martin, EG. HIV Testing Update. New Jersey AIDSLine, 9(1):14-28, Wesolowski1 LG, Ethridge SF, Martin EG, Cadoff EM and MacKellar DA. Rapid Human Immunodeficiency Virus (HIV) Test Quality Assurance Practices and Outcomes among Testing Sites Affiliated with 17 Public Health Departments. Journal of Clinical Micro. October : ; doi: /jcm Epub 2009 Aug Martin EG, Salaru G, Paul, SM and Cadoff EM. Use of a Rapid HIV Testing Algorithm to Improve Linkage to Care. Journal of Clinical Virology Dec; 52 Suppl 1:S11-5. Epub 2011 Oct 7. PMID: Stevinson K., Martin EG, Marcella S, Paul SM. Cost Effectiveness Analysis of the New Jersey Rapid Test Algorithm for HIV Testing In NJDHSS Funded Testing Sites. Journal of Clinical Virology S: S Epub 2011 Nov 9. PMID: Martin EG. Current US HIV Public Health Strategies: Reflections on an Era of Globalization and Transatlantic Collaboration. Proceedings of the 26 th SVU World Congress. Volume 1. Editors: Z. David, K. Raska and E.G. Martin. Czechoslovak Society of Arts and Sciences (SVU) ISBN Martin, EG, Salaru G, Mohammed D, Coombs R, Paul S and Cadoff E. Finding those at risk: AHI in Newark, NJ. Journal of Clinical Virology. 58S (2013) e24 e Mohammed DY, Martin EG, Sadashigie C, Jaker M, and Paul SM An Anonymous Unlinked Survey of the Sero-Prevalence of HIV/HCV antibody in an Urban Emergency Department Journal of Clinical Virology. 58S (2013) e19 e23. Since 2005 ABSTRACTS: 44 absracts 29 posters - 15 PLATFORM PRESENTATIONS: