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Rapid HIV testing algorithm increased linkage to care

Issue: March 2011

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BOSTON — A rapid HIV testing algorithm used in publicly funded HIV counseling and testing sites decreased the proportion of patients lost to follow-up and increased linkage to care, according to new findings presented here.

“CDC is leading efforts to expand HIV testing in the United States,” Kevin P. Delaney, MPH, of the division of HIV/AIDS Prevention at the CDC, said during a presentation. “Two goals of the National HIV/AIDS strategy are to increase the proportion of persons living with HIV who are aware of their infection and to increase the proportion of newly diagnosed HIV cases who receive medical care.”

Counselors across nine publicly funded HIV counseling and testing sites in Los Angeles and San Francisco were trained to perform a rapid HIV test, and if positive, immediately give a second rapid test and refer those individuals to HIV care.

A total of 17,701 people were tested between 2008 and 2009. Researchers then compared these results with 43,393 off-site confirmatory testing results across 23 different rapid HIV testing sites.

The positive predictive value was 90% for a single rapid HIV test compared with 100% for the rapid HIV testing algorithm. Only 47% of patients with preliminary positive test results returned for their confirmatory test results with the single rapid test, whereas all patients with positive rapid HIV testing algorithm results received referral to care during the same visit.

Moreover, those who received a referral were 67% more likely to be in care within 90 days vs. those who received a preliminary positive test result, but did not return for their confirmatory test results and referrals (49%, P<.0001), according to Delaney.

“Had the rapid HIV testing algorithm been available at all sites during the study, we estimate that an additional 162 HIV-positive clients may have been able to be linked to care if they didn’t have the opportunity to go away and not come back,” he said.

Delaney said the most important determinate of an HIV-infected patient being engaged in medical care within 90 days of their initial rapid test was receiving a referral for HIV care. “Using a second rapid HIV test had the added benefit of distinguishing persons who were truly infected from those with a false-positive test.” – by Ashley DeNyse

For more information:

• Delany K. #132LB.Presented at: 18th Conference on Retroviruses and Opportunistic Infections; Feb. 27-March 3, 2011; Boston.

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