Oral Fluid Testing Research Articles

Self-testing, communication and information technology to promote HIV diagnosis among young gay and other men who have sex with men (MSM) in Brazil.

Self-testing, communication and information technology to promote HIV diagnosis among young gay and other men who have sex with men (MSM) in Brazil.

Driving While Stoned: Issues and Policy Options

THC is the intoxicant most commonly detected in US drivers, with approximately 13% of drivers testing positive for marijuana use, compared to the 8% that show a measurable amount of alcohol (NHTSA, 2015). (The two figures are not strictly comparable because cannabis remains detectable for much longer than alcohol, and also for long after the driver is no longer impaired; therefore, the difference in rates does not show that stoned driving is more common than drunk driving.) Cannabis intoxication has been shown to impair reaction time and visual-spatial judgment. Many states, including those where cannabis sales are now permitted by state law, have laws against cannabis-impaired driving based on the drunk-driving model, defining criminally intoxicated driving as driving with more than a threshold amount of intoxicant in one’s bloodstream — a per se standard — as opposed to actual impairment. That approach neglects crucial differences between alcohol and cannabis in their detectability, their pharmacokinetics, and their impact on highway safety. Cannabis intoxication is more difficult to reliably detect chemically than alcohol intoxication. A breath alcohol test is (1) cheap and reliable; (2) sufficiently simple and non-invasive to administer at the roadside; and (3) a good proxy for alcohol in the brain, which in turn is (4) a good proxy for subjective intoxication and for measurable driving impairment. In addition, (5) the dose-effect curve linking blood alcohol to fatality risk is well-established and steep. None of those things is true for cannabis. A breath test remains to be developed. Oral-fluid testing can demonstrate recent use but not the level of impairment. A blood test requires a trained phlebotomist and therefore a trip to a medical facility, and blood THC levels drop very sharply over time-periods measured in minutes. Blood THC is not a good proxy either for recency of use or for impairment, and the dose-effect curve for fatality risk remains a matter of sharp controversy. The maximum risk for cannabis intoxication alone, unmixed with alcohol or other drugs, appears to be more comparable to risks such as talking on a hands-free cellphone (legal in all states) than to driving with a BAC above 0.08, let alone the rapidly-rising risks at higher BACs. Moreover, the lipid-solubility of THC means that a frequent cannabis user will always have measurable THC in his or her blood, even when that person has not used recently and is neither subjectively intoxicated nor objectively impaired. That suggests criminalizing only combination use, while treating driving under the influence of cannabis (however this is to be proven) as a traffic offense, like speeding.

Nicotine and cotinine in oral fluid: Passive exposure vs active smoking

Scheidweiler and colleagues have clinically tested and identified a reporting cutoff (10 ng/mL) of nicotine and cotinine in oral fluid that could reliably determine active smoking in patients. The results from that study were reevaluated using a large data set of oral fluid nicotine and cotinine results available from pain medication monitoring. Additionally, test results from patients using a nicotine transdermal patch delivery device are compared with those from smokers. Finally, oral fluid test results collected over a 2-year period were normalized and transformed to yield a near Gaussian distribution for nicotine. The normalized and transformed data reveal the presence of two independent populations: a larger population consistent with active smokers and a smaller population consistent with those passively exposed to smoke. Furthermore, application of this model to patients prescribed transdermal nicotine reveals oral fluid levels consistent with those of active smokers. The clinical delineation of smokers from non-smokers reported earlier is supported by the oral fluid nicotine data modelling presented herein. These data indicate that oral fluid is an acceptable sample matrix for determining the smoking status of patients. Further, these data indicate that oral fluid test results are indistinguishable between patients prescribed transdermal patches and active smokers; however, oral fluid testing can determine absence of patches or smoking.

Debates in Pain Management Testing

The annual healthcare costs associated with chronic pain are significant. Chronic pain also has important societal implications including the increasing availability of prescription narcotics. Recent literature and several professional societies have recommended urine drug testing to monitor adherence to prescription medications and to detect drug abuse and/or misuse. The technical benefits of urine drug testing using definitive testing methods such as LC-MS/MS are well documented. However, the guidelines, literature, and expert consensus on other aspects of pain management testing are sparse and/or more controversial. While many institutions and laboratories perform some form of validity and adulterant testing, the extent and utility of testing in pain management is not standardized. The benefits of point-of-care testing and the resources required to maintain a robust testing program are also not well studied. Furthermore, while urine testing is currently the gold standard in pain management, recent literature has shown some benefits of testing oral fluid and other matrices. There continue to be analytical and billing challenges with pain management testing. The utility of quantitative, definitive testing is controversial. Some laboratories only report qualitative results, while others find value in reporting some or all results quantitatively. Furthermore, the practice of laboratory professionals providing formal consultations for pain management testing and/or billing for interpretations is variable. Finally, pharmacogenomic testing is not routinely done in pain management, but some studies suggest it may be beneficial. Here we ask 7 individuals their expert opinion on different aspects of drug testing to assess compliance in pain management. Which validity and adulterant testing (e.g., observation of specimen collection, recording urine temperature immediately after collection, chain of custody, creatinine, specific gravity, pH, oxidants, nitrites) should be required? William Clarke: If there is a low suspicion for adulteration, measuring temperature, specific gravity, and creatinine should be sufficient. If tampering with the specimen …

J-103 Performance and usability of the OraQuick® HIV Self-test, an oral fluid based HIV self-test, in South Africa

With 30% of persons living with HIV globally still not knowing their status, increasing access to HIV testing using self-tests is an approach to achieving the United Nations' target goal of diagnosing 90% of all people living with HIV by 2020. The OraQuick HIV Self-Test is an oral fluid based self-test providing results in as little as 20 minutes and is the first self-test to receive WHO Prequalification (July 2017). WHO Prequalification allows access to high quality, easy to use, accurate HIV self-testing in countries wishing to broaden their HIV testing and treatment programs. This talk describes the results and observations of studies conducted in South Africa to demonstrate ease of use and generation of accurate results in the hands of a lay user. The OraQuick® HIV Self-Test results were compared to results from a fourth Gen EIA with sensitivity of 100% (n=76) and specificity of 99.1% (n=324). A separate comprehension study was conducted to assess lay users' ability to understand information provided on the outer packaging and product insert. Comprehension scores were high 99.5% (n=200) for all critical and safety related concepts. Understanding of the next steps for positive results was 97.5% (n=200) [1]. Many studies have shown and continue to demonstrate that the OraQuick HIV Self-Test is a robust test that provides accurate and reliable results. Incorporating an easy to use oral fluid test into current HIV testing strategies can increase the number of individuals testing, especially those hard to reach high risk populations currently not accessing testing.

Evaluation of three rapid oral fluid test devices on the screening of multiple drugs of abuse including ketamine

Rapid oral fluid testing (ROFT) devices have been extensively evaluated for their ability to detect common drugs of abuse; however, the performance of such devices on simultaneous screening for ketamine has been scarcely investigated. The present study evaluated three ROFT devices (DrugWipe® 6S, Ora-Check® and SalivaScreen®) on the detection of ketamine, opiates, methamphetamine, cannabis, cocaine and MDMA.A liquid chromatography tandem mass spectrometry (LCMS) assay was firstly established and validated for confirmation analysis of the six types of drugs and/or their metabolites. In the field test, the three ROFT devices were tested on subjects recruited from substance abuse clinics/rehabilitation centre. Oral fluid was also collected using Quantisal® for confirmation analysis.A total of 549 samples were collected in the study. LCMS analysis on 491 samples revealed the following drugs: codeine (55%), morphine (49%), heroin (40%), methamphetamine (35%), THC (8%), ketamine (4%) and cocaine (2%). No MDMA-positive cases were observed.Results showed that the overall specificity and accuracy were satisfactory and met the DRUID standard of >80% for all 3 devices. Ora-Check® had poor sensitivities (ketamine 36%, methamphetamine 63%, opiates 53%, cocaine 60%, THC 0%). DrugWipe® 6S showed good sensitivities in the methamphetamine (83%) and opiates (93%) tests but performed relatively poorly for ketamine (41%), cocaine (43%) and THC (22%). SalivaScreen® also demonstrated good sensitivities in the methamphetamine (83%) and opiates (100%) tests, and had the highest sensitivity for ketamine (76%) and cocaine (71%); however, it failed to detect any of the 28 THC-positive cases. The test completion rate (proportion of tests completed with quality control passed) were: 52% (Ora-Check®), 78% (SalivaScreen®) and 99% (DrugWipe® 6S).

High Acceptability and Increased HIV-Testing Frequency After Introduction of HIV Self-Testing and Network Distribution Among South African MSM.

South African men who have sex with men (MSM) have a high burden of undiagnosed HIV infection and HIV-testing rates incommensurate with their risk. HIV self-testing (HIVST) may increase testing uptake, frequency, and earlier HIV detection and treatment. Gert Sibande and Ehlanzeni districts, Mpumalanga Province, South Africa. We conducted a longitudinal HIVST study among MSM between June 2015 and May 2017. Overall 127 HIV-negative MSM were provided with up to 9 test kits of their choice-oral fluid or blood fingerstick-to use themselves and distribute to their networks. Surveys conducted 3- and 6-month post-enrollment elicited information on HIVST experiences, preferences, acceptability, utilization, and distribution. We used generalized estimating equations to assess changes in testing frequency. Ninety-one percent of participants self-tested. All participants who self-tested reported being likely to self-test again, with over 80% preferring HIVST to clinic-based testing. Fingerstick was preferred to oral fluid tests by approximately 2:1. Returning participants distributed 728 tests to sexual partners (18.5% of kits), friends (51.6%), and family (29.8%). Six participants seroconverted during the study, and 40 new diagnoses were reported among test recipients. Frequent (semi-annual) testing increased from 37.8% before the study to 84.5% at follow-up (P < 0.001), and participants reported anticipated frequent testing of 100% if HIVST were available compared with 84% if only clinic-testing were available in the coming year (P < 0.01). HIVST use and network distribution is acceptable and feasible for MSM in South Africa and can increase testing uptake and frequency, potentially improving early detection among MSM and their networks.

Validity of oral fluid test for Delta-9-tetrahydrocannabinol in drivers using the 2013 National Roadside Survey Data

BackgroundDriving under the influence of marijuana is a serious traffic safety concern in the United States. Delta 9-tetrahydrocannabinol (THC) is the main active compound in marijuana. Although blood THC testing is a more accurate measure of THC-induced impairment, measuring THC in oral fluid is a less intrusive and less costly method of testing.MethodsWe examined whether the oral fluid THC test can be used as a valid alternative to the blood THC test using a sensitivity and specificity analysis and a logistic regression, and estimate the quantitative relationship between oral fluid THC concentration and blood THC concentration using a correlation analysis and a linear regression on the log-transformed THC concentrations. We used data from 4596 drivers who participated in the 2013 National Roadside Survey of Alcohol and Drug Use by Drivers and for whom THC testing results from both oral fluid and whole blood samples were available.ResultsOverall, 8.9% and 9.4% of the participants tested positive for THC in oral fluid and whole blood samples, respectively. Using blood test as the reference criterion, oral fluid test for THC positivity showed a sensitivity of 79.4% (95% CI: 75.2%, 83.1%) and a specificity of 98.3% (95% CI: 97.9%, 98.7%). The log-transformed oral fluid THC concentration accounted for about 29% of the variation in the log-transformed blood THC concentration. That is, there is still 71% of the variation in the log-transformed blood THC concentration unexplained by the log-transformed oral fluid THC concentration. Back-transforming to the original scale, we estimated that each 10% increase in the oral fluid THC concentration was associated with a 2.4% (95% CI: 2.1%, 2.8%) increase in the blood THC concentration.ConclusionsThe oral fluid test is a highly valid method for detecting the presence of THC in the blood but cannot be used to accurately measure the blood THC concentration.

Oral Fluid Drug Testing in Pain Management Practice: Factors to Consider Before Choosing the Alternative Biological Matrix.

As the use of pharmacological agents, particularly opioid analgesics, has increased in the past 2 decades, so have the substance abuse risks, along with the prevalence of overdose deaths, addiction, and illicit drug use. Accordingly, close monitoring of patients to ensure medication compliance and to identify improper drug use becomes a critical task for pain-management practitioners. Oral fluid is an emerging biological matrix for clinical drug testing. It offers noninvasive, less hazardous, and directly observable sample collection with minimal potential for adulteration. Oral fluid can be collected multiple times in a short period and shows a stronger correlation with blood than urine concentrations. Usability of oral fluid testing had been limited by the sensitivity of analytical methods. The volume of oral fluid samples is typically much smaller than that of urine samples. Furthermore, oral fluid drug concentrations can be 10- to 100-fold lower than urine concentrations depending on analytes. Recent advances in analytical technologies lead to the growing popularity of oral fluid testing and subsequent need for scientific data to aid in interpretation of oral fluid test results. This review presents preanalytical, analytical, and postanalytical considerations associated with oral fluid drug testing for those contemplating the implementation of this alternative biological matrix in pain-management practice. Comparison with urine testing, collection procedure, drug stability, available technologies, scope of analysis, and drug disposition are discussed. As with other monitoring tools, oral fluid testing has advantages and limitations. The most important consideration is staying informed to use the testing within its capability.

Use of Metabolic Ratios of Drugs in Urine for Monitoring Pain Management Patients

This is my opinion about the utility of urine metabolic ratios (MRs)2 in the setting of providing laboratory services for pain management patients. In the following sections, I define the MR and some terms related to it, and describe the urine drug testing services at my institution. The MR's utility and limitations are then reviewed, followed by a summary. This institution's core/chemistry laboratory serves the immediate drug testing needs of the 950-bed main hospital, its emergency department, and an outpatient department generating about 1500 urine and 600 oral fluid drug screens per month; typically, fewer than 100 of the oral fluid screens have a simultaneously collected urine sample tested for comparison. Urine screens provide qualitative immunoassay results, and oral fluid tests provide quantitative LC-MS/MS results. Clarification of unexpected urine results is performed by LC-MS/MS at a reference laboratory after consultation between the ordering clinician and a laboratory director. The urine panel detects drugs prescribed for pain management as well as illicit drugs, and includes class-specific assays for benzodiazepines (BZ), buprenorphine (BUP), methadone (METHAD), opiates (OPI), and oxycodone (OXYCOD). The MR is the ratio of a drug metabolite concentration to its parent drug concentration, expressed as a range. A parent drug will have an MR for each of its main metabolites. …

Acceptability of Oral-fluid rapid HIV 1 and 2 antibody test among selected key populations in Sri Lanka

Introduction: Oral-fluid rapid HIV 1 and 2 antibody test is recommended by WHO to be used as a “test for triage” to support expanding community-based HIV testing services among Key populations (KPs) for HIV infection such as Men who have sex with men (MSM), Beach boys (BB), Female sex workers (FSW) and Drug users (DUs) Objective: The aim of this study was to ascertain the acceptability of oral fluid rapid HIV 1/2 antibody test (OraQuick®) among key populations receiving services under the Global Fund HIV prevention project during 2013-2015 in Sri Lanka. Methods: Out of the total registered members of KPs (21,014), a purposive sample of 614 (MSM-185, BB-128, FSW-155, DU-146) was studied. Data collected by WHO certified community testers using three tools, i). interviewer administered questionnaire, ii) confidential oral fluid rapid HIV test and recording, iii), a self-administered feedback form. Results: Mean age of the sample was 34 years (Mdn=32.7 years). Males, females and transgender people were 68.9%, 30.6%, 0.5% respectively. Further, 40.7% were single, 36.5% married, 11.7% living together and 11% were separated. It seems that these groups prefer both community testing (49%) as well as outreach testing by STD staff (49%). However, going to an STD clinic was preferred only by 10%. Majority preferred oral-fluid testing (88%) and finger prick testing preferred by 10.2%. Majority expected test report just after the test (88.3%). The overall satisfaction of the oral-fluid rapid HIV test by KPs was MSM 97%, BB-99%, FSW-99%, DU-99%. Conclusions: Members of KP groups show high level of acceptability for the oral-fluid rapid HIV 1 and 2 antibody test. This type of “test for triage” approach can be used to improve the community based HIV testing in Sri Lanka.

Conducción bajo la influencia de las nuevas sustancias psicoactivas

Neurological and psychological symptoms caused by the use of new psychoactive substances (NPS) can have a major impact on an individual's ability to drive. However, there are limited data available on the prevalence of their use by drivers, the risk of a driver being injured/killed in an accident under the influence of NPS and on how driving can be adversely influenced by the consumption of these substances.Detecting NPS in drivers is complicated in both in situ oral fluid testing and in laboratory tests that require advanced technology and analytical methods that must be kept up to date. These limitations, together with the characteristics of these substances, such as the “legality” of most of them, grant impunity to those driving under the influence of NPS and represent a real danger to non-consumers.

1 Patient acceptability and feasibility of HIV testing in emergency departments in the UK – a systematic review and meta-analysis

BackgroundNICE 2016 HIV testing guidelines now include the recommendation to offer HIV testing in Emergency Departments, in areas of high prevalence,1 to everyone who is undergoing blood tests. 23% of...

A Novel Oral Fluid Assay (LC-QTOF-MS) for the Detection of Fentanyl and Clandestine Opioids in Oral Fluid After Reported Heroin Overdose.

The adulteration of heroin with non-pharmaceutical fentanyl and other high-potency opioids is one of the factors contributing to striking increases in overdose deaths. To fully understand the magnitude of this problem, accurate detection methods for fentanyl and other novel opioid adulterant exposures are urgently required. The objective of this work was to compare the detection of fentanyl in oral fluid and urine specimens using liquid chromatography quadrupole time-of-flight mass spectrometry (LC-QTOF-MS) in a population of heroin users presenting to the Emergency Department after overdose. This was a prospective observational study of adult Emergency Department patients who presented after a reported heroin overdose requiring naloxone administration. Participants provided paired oral fluid and urine specimens, which were prepared, extracted, and analyzed using a dual LC-QTOF-MS workflow for the identification of traditional and emerging drugs of abuse. Analytical instrumentation included SCIEX TripleTOF® 5600+ and Waters Xevo® G2-S QTOF systems. Thirty participants (N=30) were enrolled during the study period. Twenty-nine participants had fentanyl detected in their urine, while 27 had fentanyl identified in their oral fluid (overall agreement 93.3%, positive percent agreement 93.1%). Cohen's Kappa (k) was calculated and demonstrated moderately, significant agreement (k=0.47; p value 0.002) in fentanyl detection between oral fluid and urine using this LC-QTOF-MS methodology. Additional novel opioids and metabolites, including norfentanyl, acetylfentanyl, and U-47700, were detected during this study. In this study of individuals presenting to the ED after reported heroin overdose, a strikingly high proportion had a detectable fentanyl exposure. Using LC-QTOF-MS, the agreement between paired oral fluid and urine testing for fentanyl detection indicates a role for oral fluid testing in surveillance for nonpharmaceutical fentanyl. Additionally, the use of LC-QTOF-MS allowed for the detection of other clandestine opioids (acetylfentanyl and U-47700) in oral fluid.

Use of Oral Fluid in a Rapid Syphilis Test Assay

Background From 2014 to 2015, the syphilis rate in the United States increased by 19%, reaching its highest rate since 1994. Currently, point-of-care syphilis assays use fingerstick or venipuncture whole blood to identify Treponema pallidum (TP) antibodies by qualitative immunoassay. However, patients and providers prefer oral fluid testing to whole blood testing. In this study, we aimed to determine whether a rapid syphilis test intended for use on whole blood could be used to detect TP antibodies in oral fluid.Methods Oral fluid was collected from 72 participants using the Super•SAL™ Oral Fluid Collection Device (Oasis Diagnostics®, Vancouver, WA). The device uses an absorbent cylindrical pad to collect and filter ~1 mlml of oral fluid. Oral fluid filtrate was tested using the SD Bioline Syphilis 3.0 rapid test (Alere Diagnostics, MA) following manufacturer directions for whole blood. TP particle agglutination (TPPA) and rapid plasma reagin (RPR) results derived from participants’ medical records were used as reference values. We used three different definitions as comparators: 1: TPPA reactive; 2: TPPA and RPR reactive and 3: TPPA reactive and RPR titer >1:4. Those with non-reactive TPPA and RPR results were considered seronegative. We calculated the sensitivity and specificity for definition 1 and sensitivity for definitions 2 and 3. We used the exact binomial method to determine 95% confidence intervals (CI).ResultsWith definitions 1, 2, and 3, respectively, sensitivity was 83.3% (CI: 67.2, 93.6), 86.4% (CI: 65.1, 97.1), and 100% (CI: 71.5, 100). Specificity was 47.2% (CI: 36.5, 75.5).Conclusion The high sensitivity of the SD Bioline Syphilis 3.0 test using oral fluid suggests a strong potential for the development of accurate rapid oral syphilis tests. Sensitivity increased with higher RPR titer. False positive results may be due to the presence of non-venereal treponemal antibodies in oral fluid. Further research and development are needed to optimize specificity.Disclosures All authors: No reported disclosures.

Diagnostic accuracy and acceptability of rapid HIV oral testing among adults attending an urban public health facility in Kampala, Uganda.

BackgroundThe prevalence of HIV in Uganda is 7.3%, and yet nearly 40% of people living with HIV are unaware of their status. The current HIV testing policy which is strictly blood-based poses several challenges including: a need for high level laboratory skills, stringent waste disposal needs, and painful sample collection. It is envisaged that introduction of a rapid, painless HIV oral fluid test as a potential alternative is likely to increase the number of people testing. The aim of this study was to determine the diagnostic accuracy and acceptability of rapid HIV oral testing among adults attending Kisenyi Health Centre IV in Kampala.Methods and findingsWe conducted a cross-sectional study among 440 adults recruited consecutively at Kisenyi Health Centre IV from January to March 2016. The diagnostic accuracy of the HIV oral test was assessed by comparing to the national HIV serial testing algorithm. We also assessed for acceptability among patients and health care workers (HCWs) by triangulating responses from a structured questionnaire, three focus group discussions and seven key informant interviews. Acceptability was defined as willingness to take the test at the time of the study and intention for future use of the test if it was availed.The prevalence of HIV infection among study participants was 14.8%. The HIV oral fluid test was highly accurate with sensitivity of 100% (95% CI; 94.5–100.0), specificity of 100% (95% CI; 99.0–100.0), positive predictive value (PPV) of 100% (95% CI; 94.5–100.0) and negative predictive value (NPV) of 100% (95% CI; 99.0–100.0). Acceptability of HIV oral testing was also high at 87.0% (95% CI; 83.6–89.9). Participants preferred HIV oral testing because it was: pain free (91%, n = 399) and did not require blood draw (82%, n = 360).ConclusionThe HIV oral fluid test has high diagnostic accuracy and acceptability. HIV oral testing is a suitable addition to the national HIV testing strategies with the potential of increasing access to HIV testing services in Uganda.

Smoke on the water—Oral fluid analysis at sea

This study outlines the operational challenges and findings of an illicit drug oral fluid testing program carried out on the skippers (those in charge) of water vessels in Queensland, Australia. Between 2010 and 2016, 953 tests of skippers were conducted on water (waterside) for three proscribed illicit drugs; delta-9-tetrahydrocannabinol (THC), methylamphetamine (MA) and 3,4-methylendioxymethylamphetamine (MDMA). 126 (13%) of the skippers tested returned an on-site positive during waterside testing, 125 were confirmed positive for one or more illicit drug by subsequent laboratory analysis, whilst one skipper did not provide an oral fluid sample for confirmatory analysis. The skippers were entirely male (100%) with an average age of 39 years (range 17–59). THC was by far the most common drug detected (91%); MA was detected in 22% of skippers and a combination or THC and MA in 14% of specimens. MDMA was identified only once during the study, this being in combination with THC. As a single waterside operation can take more than a week, operational pre-planning becomes essential. Aspects of the operation such as, weather, shift times, food, testing consumables, sleeping quarters, hygiene, liaison between different agencies and multiple other factors need to be taken into account prior to commencement. A waterside operation must be mobile and, in Queensland at least, able to cover a large area of water. There is also a much lower volume of vessels likely to be encountered at sea compared to a roadside operation targeting motor vehicles.

'I will choose when to test, where I want to test': investigating young people's preferences for HIV self-testing in Malawi and Zimbabwe.

The current study identifies young people's preferences for HIV self-testing (HIVST) delivery, determines the relative strength of preferences and explores underlying behaviors and perceptions to inform youth-friendly services in southern Africa. A mixed methods design was adopted in Malawi and Zimbabwe and includes focus group discussions, in-depth interviews and discrete choice experiments. The current study was conducted during the formative phase of cluster-randomized trials of oral-fluid HIVST distribution. Young people aged 16-25 years were purposively selected for in-depth interviews (n = 15) in Malawi and 12 focus group discussions (n = 107) across countries. Representative samples of young people in both countries (n = 341) were administered discrete choice experiments on HIVST delivery, with data analyzed to estimate relative preferences. The qualitative results provided additional depth and were triangulated with the quantitative findings. There was strong concordance across methods and countries based on the three triangulation parameters: product, provider and service characteristics. HIVST was highly accepted by young people, if provided at no or very low cost. Young people expressed mixed views on oral-fluid tests, weighing perceived benefits with accuracy concerns. There was an expressed lack of trust in health providers and preference for lay community distributors. HIVST addressed youth-specific barriers to standard HIV testing, with home-based distribution considered convenient. Issues of autonomy, control, respect and confidentiality emerged as key qualitative themes. HIVST services can be optimized to reach young people if products are provided through home-based distribution and at low prices, with respect for them as autonomous individuals.

Evaluation of Oral Fluid as a Specimen for DUID.

Drugged driving has become more prevalent than drunk driving and is quickly gaining national attention due to increased prescription drug abuse and recent cannabis legalization. Unlike alcohol, police officers do not generally have access to approved devices to screen for drugs at the roadside. Onsite drug screening devices do exist and are used in other countries, but have not garnered widespread approval for use in the United States in driving under the influence of drugs (DUID) cases. One reason for this is that the devices are designed to test oral fluid, which is not a commonly accepted specimen for DUID. A study was conducted to test the effectiveness of using oral fluid during routine traffic stops in DUID cases in conjunction with drug recognition expert (DRE) officers from the Tulsa Police Department (TPD). Samples were screened at the roadside using an Alere DDS®2 Mobile Test System and Quantisal™ collection devices were used for laboratory based screening by enzyme-linked immunosorbent assay and confirmation by liquid chromatography-tandem mass spectrometry. The results of the DRE observations, alternate specimens like blood and urine, onsite oral fluid screening and laboratory based oral fluid screening and confirmations were used to assess the usefulness of oral fluid as a DUID specimen. Due to the small sample size (N = 9), no significant differences in the measured performance of onsite and laboratory based tests was seen. The results of this study indicate that oral fluid testing is a viable option both at the roadside and in a laboratory setting.

Efficacy of alpha-lipoic acid in chronic generalized periodontitis in patients with infiltrative pulmonary tuberculosis

Aim. To study clinical efficacy of chronic generalized periodontitis treatment in patients with infiltrative pulmonary tuberculosis with the use of α-lipoic acid. &#x0D; Methods. 50 patients with chronic generalized periodontitis and infiltrative pulmonary tuberculosis randomly divided into 2 groups were examined. The study group included 25 patients who had received α-lipoic acid «Octolipen» in complex treatment for 3 months. The comparison group included 25 patients who were administered complex treatment of tuberculosis and periodontitis without α-lipoic acid. All patients on admission and dynamically after 3 months of treatment had routine clinical studies, cytology analysis of capillary gingival blood and gingival fluid and cytokine status testing of oral fluid. &#x0D; Results. Patients with chronic generalized periodontitis combined with infiltrative pulmonary tuberculosis who received «Octopilen» had statistically significant positive dynamics of clinical signs and decrease of basic dental indices after 3 months of treatment compared to baseline data. Dynamics of IL-1β, tumor necrosis factor α and IL-4 revealed significant decrease of these cytokines concentration in gingival fluid in patients from both groups after 3 months of treatment. &#x0D; Conclusion. Inclusion of α-lipoic acid product to complex treatment of patients with chronic generalized periodontitis combined with infiltrative pulmonary tuberculosis leads to faster clinical remission.