Steven Saunders, Director, HIV Prevention, NJDOH errol.saunders@doh.state.nj.us
Wit ithout t the Rapid id-Rap apid id Testin ing g Alg lgorit ithm, hm, Lin inkage ge to Ca Care re on the Sa Same or r Ne Next Business iness Day Would ld Not Be Be Po Possi sibl ble BUT, changing testing strategies alone won’t solve all the problems, it’s only one tool. NJ rethoug ught ht it its whole le appr proac ach h to te testing ing and li linkage ge entir irel ely, y, in inclu ludi ding ng RTA.
Principle: ◦ The use of two different immunoassays employing different HIV antigens to search for HIV antibodies. (Term: O RTHOGONAL A SSAYS ) ◦ Evaluated in trials in NJ from 2004-Present. ◦ More than 100,000 have been tested in New Jersey using an RTA ◦ It successfully verifies a true HIV + >99.5% of the time! Practice: ◦ CDC Surveillance issued guidance in November, 2011 permitting the ‘Presumptive Diagnosis’ of individuals positive by rapid screening utilizing 2 different assays. ◦ The designation of P RESUMPTIVE D IAGNOSIS means that additional testing CD4, viral load will affirm the diagnosis
120 test t sites s acr cross ss state te & 6 & 60,000 tests ts/yr /yr Combina binatio tion n of blood od testing, ting, oral Or Orasure ure and rapid d testing ing Ov Overal rall l test t result lt deliver very y rate only y c. c. 65% Movement vement towar ard d Rapid Testing ng only Te Testing ng at at CB CBOs Os was as an an initi tial al rap apid d tes est with h ei either her on on-site ite or referra rral l for Wb blood od draw Even n with a p predominantl ominantly y rapid d testing ing program ram by y 20 2009 09, o over eral all, l, 22 22% of prel eliminary iminary positives tives fai ailed ed to return rn for their r test t results lts Jumped ped to 45% f for rapid d testi ting ng CBOs Os
Movement in NJ to rapid testing only by 2009, eliminating the need to return for initial screening test results Elimination of Wb as sole confirmatory test Adoption of Rapid-Rapid testing algorithm (RTA) for higher volume test sites Establishing eight Navigator Programs within HIV care settings to perform 2 nd rapid test for non RTA test sites Local Linkage to Care Collaboratives covering all 21 counties
Ha Harnes ness s the e collec ecti tive ve imp mpact ct of share ared d go goals s among ng the diverse verse organ ganizati zations ons that provid ovide e HI HIV and d related ated servi rvices ces to solve ve the probl blem em of linking king new ewly y diagnosed gnosed patien ents ts to care e and d re-engaging engaging those se lost to care
Commo mmon n Agenda da among all local providers – shared goals and how to achieve them Shared ed Measuremen urement among all local providers – vigilantly keeping track of linkage to care on the client-level Mutual ually ly Reinfo forcing cing Act ctivi ivitie ties – each agency providing its own services using their unique skills and resources Conti tinuous nuous Commun munica cati tion on – regularly sharing results with each other Back ckbone bone Or Organization nization – mobilize, coordinate and facilitate to keep goal in sight and progress moving
Expand nd HIV testing ing targe geting ting thos ose e who do not know w their r status, tus, especi cial ally ly among ong partne ners rs of HIV+ V+ Fully y impl pleme ement nt RT RTA t to the e ex extent ent possibl sible Linking nking HIV+ V+ who are not in ca care on the same or next t busine iness ss day Address ess and reduce ce stigma gma within hin prov ovider der agencies cies Assign gn one liaison on as the agency cy lead in local cal co collaborations aborations Ensur ure e transpor nsportation tation to faci cili litate tate a s succe ccessful ssful linka kage ge
Succes ess s is measure sured d at the client-level evel Linkag nkage e to care e is the e ultimate mate outcome me measure sure Eve very ry collaborating borating age genc ncy y plays ys a role e in linkag kage e to care (initi tial al and/or d/or reengagement) ngagement) Vigi gilant ant follow- up of each agency’s role in linking king a particul rticular ar clien ent
An MOA OA was developed loped in Camde den n and anothe ther r is in development elopment for Atlantic, ntic, Cape May y and Cumbe berla rland nd Counti nties es Each ch agency cy lists s its servi vice ces s with h a co contac tact t numbe mber r (ce cell) ) to permit it direct ct co communi mmunica catio tion n and linkage kage with no red tape. . Typ ypes of service vice offer ered ed by y agenc ncies es incl clude ude transpor sportati tation on on demand, and, preventi vention on servic vices es targeting eting high-ri risk sk popula ulatio tions, ns, bi-li lingu ngual l ca capacity city and legal service vices. s. In Atlantic tic City y the list also incl clude udes s mental tal health, th, dental al, , and drug g treatme tment nt on demand. nd.
Lead ad age genc ncy y fund nded ed wi with Categori egories es B an B and d C CDC Pr Preve venti ntion on fund nds s to supp pport ort Pa Patient ent Na Navi vigat gator or Navi vigat gator or employed oyed by EIP/I P/ID D Clinic c and d wo works ks embedde edded d wi within n a care e setting ing Eight Navigator Programs established in NJ’s high ghest est preva valen ence e cities: s: Camden en, , Atlanti ntic c City, , Jersey rsey City, , Neptune tune Pa Paters erson, on, Elizabeth abeth and d Ne Newa wark rk (2) 2)
Prim imary ry func nction ion is is Lin inkage ge to C Care Na Navi vigator gator Program gram activiti ivities: es: • Provide 2 nd rapid test for patients testing + on their 1 st rapid test at CBOs – same or next business day • Immediately enroll confirmed +s into care (initial work-up CD4, VL on same day as 2 nd rapid test) • Partner Services for new and existing clinic patients using CE and Social Networking • Re-engagement of lost to care patients • Treatment adherence and prevention counseling • Collaborative Point Person and MOA Manager • Advocate for routine (hospital-wide) HIV screening
Each ch agency cy prov ovides des its own servi vice ces s using ng their ir unique que skills ls and resour ource ces Initial Stat-Pak rapid HIV test at CBO Second, Unigold confirmatory rapid HIV test at Patient Navigator clinical site Immediately begin HIV medical care with initial HIV work-up (CD4, VL, etc.) since Navigator is part of ID practice Social networking, lost to care, Navigator works with CBOs who have access to target communities and individuals On-going HERR prevention for positives at CBOs
1st + rapid test conducted in a non clinical setting is not immediately followed by a second rapid in a clinical setting Second rapid + is not followed by an immediate linkage to care (lab tests for VL and CD4) Patient lost to care, referred by collaborative or not HIV+ who does not access ARV as soon as medically possible HIV+ who does not have an undectable viral load, not otherwise medically explained Out of care HIV+ pregnant women who does not experience the collective resources of the collaboration
Preliminary data, July - November 2012 • Six Collaboratives reporting • Majority African American (60%) male (69%) • 17% Hispanic • 20% were 18-25 years old • 240 total HIV tests (1 st & 2 nd ); 86 positive (36%) • 47 of 240 total were 2 nd rapids, 43 positive (91%) • 74% of confirmed positives had initial HIV lab work- up within two working days • 17 partners tested, 4 positive (24%) • 7 social contacts tested, 1 positive (14%) • 88 patients re-engaged in care
Quality Assurance is expensive. 1. The majority of specimens run for a second rapid in an RTA are run to comply with QA requirements Quality Control Proficiency Testing Competency Assessment 2. Operators who use specimen types infrequently can be easily confused - particularly when they are under stress 3. CONCLUSION: It doesn’t make sense to make every site an RTA site
4 th Generation HIV Screening in Massachusetts: A Partnership between Laboratory and Program NASTAD Webinar December 4, 2012 Tammy Goodhue and Barry Callis Massachusetts Department of Public Health Bureau of Infectious Disease, Office of HIV/AIDS
Massachusetts Department of Public Health (MDPH): Set a goal to transition from 3 rd to 4 th Generation HIV screening for all serum samples: – Collected at all Office of HIV/AIDS (OHA) funded Prevention & Screening sites statewide – Tested at the Hinton State Laboratory Institute (HSLI) Endeavored to accomplish this goal within six months (January – June 2012) Successfully made this transition within the allotted time
OHA Prevention & Screening System Overview Hinton State Laboratory Institute OHA-funded HIV testing is offered: • At 75 program locations • In 27 cities/towns across MA • During a variety of hours • By ~ 275 individuals • Using rapid & conventional sample collection methods
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