Abstract
HIV rapid testing algorithms (RTAs) using any two orthogonal rapid tests (RTs) allow for on-site confirmation of infection. RTs vary in performance characteristics therefore the selection of RTs in an algorithm may affect identification of infection, particularly if acute. National HIV Behavioral Surveillance (NHBS) assessed RTAs among men who have sex with men recruited using anonymous venue-based sampling. Different algorithms were evaluated among participants who self-reported never having received a positive HIV test result prior to the interview. NHBS project areas performed sequential or parallel RTs using whole blood. Participants with at least one reactive RT were offered anonymous linkage to care and provided a dried blood spot (DBS) for testing at CDC. Discordant results (RT-1 reactive/RT-2 non-reactive) were tested at CDC with lab protocols modified for DBS. DBS were also tested for HIV-1 RNA (VL) and antiretroviral (ARV) drug levels. Of 6500 RTAs, 238 were RT-1 reactive; of those, 97.1% (231/238) had concordant results (RT-1/RT-2 reactive) and 2.9% (7/238) had discordant results. Five DBS associated with discordant results were available for confirmation at CDC. Four had non-reactive confirmatory test results that implied RT-1 false reactivity; one had ambiguous confirmatory test results which was non-reactive in further testing. Regardless of order and type of RT used, RTAs demonstrated high concordant results in the population surveyed. Additional laboratory testing on DBS following discordant results confirmed no infection. Implementing RTAs in the context of anonymous venue-based HIV testing could be an option when laboratory follow-up is not practicable.
Highlights
Nonclinical testing settings allow HIV testing programs to reach populations at increased risk who otherwise might not engage in regular HIV testing
We evaluated the third nonclinical testing algorithm within National HIV Behavioral Surveillance (NHBS), which conducts anonymous cross-sectional behavioral surveys and HIV testing in annual rotating cycles with men who have sex with men (MSM), persons who inject drugs, and heterosexually active persons at increased risk for HIV
Project areas and 1 p-rapid testing algorithms (RTAs) project area) NHBS project areas included in this analysis
Summary
Nonclinical testing settings allow HIV testing programs to reach populations at increased risk who otherwise might not engage in regular HIV testing. We evaluated the third nonclinical testing algorithm within National HIV Behavioral Surveillance (NHBS), which conducts anonymous cross-sectional behavioral surveys and HIV testing in annual rotating cycles with men who have sex with men (MSM), persons who inject drugs, and heterosexually active persons at increased risk for HIV. Until 2017, NHBS participants received one RT and, if reactive or preliminary positive, confirmation was performed using laboratorybased HIV IgG/IgM or Ag/Ab immunoassays at local or CDC laboratories. This created a barrier to knowledge of confirmed HIV status as participants needed to call or return in 1–2 weeks for confirmatory results [7]. A meta-analysis found that participants who received a RT were 1.5–2.2-times more likely to obtain their test results than those who received standard laboratory testing [10]
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