acute infection screening and prevention (aisap)
DESCRIPTION
Acute Infection Screening and Prevention (AISAP). Pat Simmons Florida Department of Health Division of Disease Control Bureau of HIV/AIDS Early Intervention Program Counseling and Testing Section. AREA 14. AREA 1. AREA 9. AREA 3. AREA 5. HARDEE. PALM BEACH. ESCAMBIA. ALACHUA. PASCO. - PowerPoint PPT PresentationTRANSCRIPT
Acute Infection Screening and
Prevention (AISAP)Pat Simmons
Florida Department of HealthDivision of Disease Control
Bureau of HIV/AIDSEarly Intervention Program
Counseling and Testing Section
AREA 1
ESCAMBIA
OKALOOSA
SANTA ROSA
WALTON
AREA 2
BAY
CALHOUN
FRANKILIN
GADSDEN
GULF
HOLMES
JACKSON
JEFFERSON
LEON
LIBERTY
MADISON
TAYLOR
WAKULLA
WASHINGTON
AREA 3
ALACHUA
BRADFORD
COLUMBIA
DIXIE
GILCHRIST
HAMILTON
LAFAYETTE
LEVY
PUTNAM
SUWANNEE
UNION
AREA 4
BAKER
CLAY
DUVAL
NASSAU
ST JOHNS
AREA 5
PASCO
PINELLAS
AREA 6
HILLSBOROUGH
MANATEE
AREA 7
BREVARD
ORANGE
OSCEOLA
SEMINOLE
AREA 8
CHARLOTTE
COLLIER
DESOTO
GLADES
HENDRY
LEE
SARASOTA
AREA 9
PALM BEACH
AREA 10
BROWARD
AREA 11
DADE
MONROE
AREA 12
FLAGLER
VOLUSIA
AREA 13
CITRUS
HERNANDO
LAKE
MARION
SUMTER
AREA 14
HARDEE
HIGHLANDS
POLK
AREA 15
INDIAN RIVER
MARTIN
OKEECHOBEE
ST LUCIE
Florida AISAP Study Counties ESCAMBIA
SANTA ROSA
OKALOOSA
WALTON
HOLMES
WASHINGTON
BAY
JACKSON
CALHOUN
GULF
LIBERTY
FRANKLIN
GADSDEN
LEON
WAKULLA
JEFFERSON
TAYLOR
MADISON
HAMILTON
SUWANNEE
LAFAYETTE
DIXIE
LEVY
GILCHRIST
COLUMBIA
ALACHUA
UNION
BRADFRD
NASSAU
MARION
CITRUS
HERNADO
PASCO
SUMTER
LAKE
PUTNAM
CLAY
BAKER
DUVAL
ST JOHNS
FLAGLER
VOLUSIA
SEMINOLE
ORANGEBREVARD
OSCEOLA
POLK
HILLSBOROUGH
PINELLAS
MANATEE HARDEE
DESOTO
CHARLOTTE
LEE
GLADES
HENDRY
COLLIER
MONROEDADE
BROWARD
PALM BEACH
MARTIN
ST LUCIE
OKEECHOBEE
INDIAN RIVER
HIGHLANDS
11
10
9
15
7
12
4
3
2
1
13
5
6
8
14
SARASOTA
Duval, Hillsborough, Pinellas, Orange
Florida discovered:
• Use the best plasma collection tubes• Ensure specimen integrity • Incorporate negative rapids with NAAT • Designate an AHI DIS or CTL person• If possible, target NAAT for high risk• Be aware of client ART history
The Sites and DIS:• Collect, spin, ship• Respond before lab
result is mailed • Contact client as
quickly as possible• Initiate field
records• Confirmation draw
The Lab:• Antibody screening • Pooling or individual
NAAT • Viral loads • Report out as quickly
as possible
Collecting, Testing, Imparting, and Confirming
AHI and the DIS
• Call 9-1-1 DIS• Explain test results to clients• Linkage or referral to services • Partner Services • Pull confirmatory sample • Obtain follow-up appointment
Client Results 1st VL 2nd VL
P1 EIA - NAAT + 1,381,600 916,500
P2 EIA + WB I NAAT + 6,334,400 21,856
P5 EIA + WB - NAAT + 138,126 UTL
P6 EIA - NAAT + 241,547 1,204,000
P7 EIA - NAAT+ 8,700 15,900
P8 EIA - NAAT+ 204,100 53,100
P10 EIA + WB I NAAT + 1,024,000 101,300
P11 EIA - NAAT + 9,900 3,436
P12 EIA + WB I NAAT + 47,700 92,900
P14 EIA + WB - NAAT + 3,397,400 Anonymous
P15 RT – NAAT + 111,127 Pending
Total of 14 AHI Results 11 of which were true
AHI
8 Seroconverted antibody positive 3 False positive NAAT 1 Pending redraw 1 Unable to locate 1 Anonymous – Unable to locate
False NAAT Impact • 3 false positive NAAT• 2 before lab rectified • 1 after lab rectified• 2 pregnant• 1 non-English speaker
NAAT post-test counseling:Shock, denial, lots of questions, partners
cooperative
Negative serostatus post-test counseling:Lots of questions, willing to test for other STDs
AHI Snapshots
• Client did not want to receive seroconversion results, STD Hx, has tested again
• Client has alias names and addresses, STD and drug use Hx
• Client was discovered as a part of a syphilis cluster investigation
• Client is homeless, MH issues, lack of HIV knowledge, took several DIS to locate
RT Negative Client
Test Result (10/11)
Result (10/17)
OraQuick Finger stick
Non-Reactive
EIA N/A Negative
WB N/A All bands negative
NAAT NA Positive
VL N/A 111,127
AHI Partner Services
• 29% not located (4)• 71% located (10)
• 70% were tested (7)• 43% new HIV positives (3)• 29% new HIV negatives (2)• 29% repeat negatives (2)
EIA / NAAT “Discordants”
• 1st client positive since mid 1990’s and does not claim any ART
• 11th client initial indeterminate /
NAAT negative; follow up concordant (positive) after two draws
First EIA / NAAT “Discordant”
Test Result (5/1) Result (5/24)
EIA RR RR
WB p24, p31, gp160
p24, gp160
NAAT Negative Negative
RT OraQuick PosMultispot Pos
N/A
VL N/A <75
CD4 CD8 Ratio
N/A 2.54
False NAAT Negative
Test Result (9/22)
Result (10/18)
Result (10/25)
EIA RR RR RR
WB p24 p24, p41, p120, p160
P24, p41 I, p120 I, p160
NAAT Negative Unsatisfactory
Positive
Lessons Learned
• Sites must fully understand AHI • Budgets need to sustain AHI detection • DIS staffing must be sufficient • Provide access to services for AHI • ART history may yield a NAAT negative• Reduce unsats
If Florida were to do this again, say in the Miami/Dade area…..
…what would be done differently?
Focus on Acute Infections
Assign a coordinator within Miami-Dade
Obtain a strong STD partnership
Include negative rapids and mobile units
Bureau of Laboratories Berry BennettSally Fordan
Olanike DavidPetirce Stephens
Bureaus of HIV/AIDS and STD
Marlene LaLotaPat Simmons
Melinda WatersDan Pope
Robert ChenDan GeorgeStacy Shiver
CDCPragna Patel
Duncan MackellarPatrick SullivanSteven EthridgeMichele OwenWalid Heneine
Clyde HartAngela HutchinsonStephanie Sansom
Paul Farnham
It takes a village…