Oral Fluid Testing Research Articles

7-Aminoclonazepam is superior to clonazepam for detection of clonazepam use in oral fluid by LC–MS/MS

BackgroundClonazepam (CLON) is not only frequently prescribed in addiction management but is also commonly abused. Therefore many addiction clinics perform oral fluid (OF) testing, which unlike urine is not subject to adulteration, to monitor CLON compliance. However, CLON and other benzodiazepines can be challenging to detect in OF due to their weakly acidic nature and their presence in low concentrations. We determined the optimal technical and clinical approach for the detection of CLON use using OF. MethodsWe measured CLON and its primary metabolite 7-aminoclonazepam (7AC) by liquid chromatography–tandem mass spectrometry in OF specimens over a 2month period. The samples were collected using the Orasure Intercept OF sample collection device. ResultsOne hundred samples were presumptive-positive for 7AC and/or CLON. 91 (91.0%) confirmed positive for 7AC (median, range: 4.2, 0.5–316.7ng/ml) using the ion ratio test, while only 44 of the 100 (44.0%) samples confirmed positive for CLON (median, range: 3.7, 0.5–217.2ng/ml) using the ion ratio test. In OF the levels of 7AC were approximately 2.4-fold higher than CLON. The use of 7AC as an analyte for the detection of both CLON compliance and undisclosed use is also recommended. Conclusions7AC should be the analyte measured in OF for the detection of CLON use.

Evaluation of Specificity and Sensitivity of Oral Fluid for Diagnosis of Hepatitis B.

Hepatitis B viral infection is a global health issue. Various screening and confirmatory serological tests have evolved in the past few decades for detection of hepatitis B. However, oral fluid as an alternative to blood could provide substantial advantages. The study aimed to evaluate the diagnostic efficacy of oral fluid in detecting hepatitis B surface antigen using Enzyme Linked Immunosorbent Assay (ELISA). Salivary and blood samples were collected from 40 seropositive and 40 seronegative patients of hepatitis B viral infection and were subjected to ELISA test for hepatitis B surface antigen. Mann-Whitney U test was used to test the statistical significance and Kappa (K) statistic was used to assess the degree of agreement between serum and oral fluid samples. The p-value <0.05 was considered as significant value. A sensitivity and specificity of 100% of oral fluid assay was obtained for the diagnosis of hepatitis B infection. The degree of agreement between saliva and serum for detection of hepatitis B was found to be perfect (Kappa value =1). Oral fluid testing can be an interesting, alternative for hepatitis B infection for diagnosis and screening for epidemiological purposes. Further research necessitates for the implementation of saliva as a diagnostic tool.

Application of Oral Fluid Assays in Support of Mumps, Rubella and Varicella Control Programs.

Detection of specific viral antibody or nucleic acid produced by infection or immunization, using oral fluid samples, offers increased potential for wider population uptake compared to blood sampling. This methodology is well established for the control of HIV and measles infections, but can also be applied to the control of other vaccine preventable infections, and this review describes the application of oral fluid assays in support of mumps, rubella and varicella national immunization programs. In England and Wales individuals with suspected mumps or rubella, based on clinical presentation, can have an oral fluid swab sample taken for case confirmation. Universal varicella immunization of children has led to a drastic reduction of chickenpox in those countries where it is used; however, in England and Wales such a policy has not been instigated. Consequently, in England and Wales most children have had chickenpox by age 10 years; however, small, but significant, numbers of adults remain susceptible. Targeted varicella zoster virus (VZV) immunization of susceptible adolescents offers the potential to reduce the pool of susceptible adults and oral fluid determination of VZV immunity in adolescents is a potential means of identifying susceptible individuals in need of VZV vaccination. The main application of oral fluid testing is in those circumstances where blood sampling is deemed not necessary, or is undesirable, and when the documented sensitivity and specificity of the oral fluid assay methodology to be used is considered sufficient for the purpose intended.

Use of alcohol and drugs by employees in selected business areas in Norway: a study using oral fluid testing and questionnaires.

BackgroundAlcohol or drug use and associated hangover may reduce workplace safety and productivity and also cause sickness absence. The aims of this study were to examine (i) the use of alcohol and drugs, and (ii) reduced efficiency at work and absence due to such use among employees.MethodsForty-four companies were invited; half of them agreed to participate. Employees filled in a questionnaire and provided a sample of oral fluid, which was analysed for alcohol, 12 psychoactive medicinal drugs and 6 illicit drugs. Participation was voluntary and anonymous.ResultsTwo thousand four hundred thirty-seven employees in eight business areas agreed to participate (92 % of those invited). By combining questionnaires and oral fluid testing, we found that 5.2 % had used psychoactive medication during the last couple of days, 1.4 % had used illicit drugs, 17.0 % had used alcohol during the last 24 h but only one person (0.04 %) was positive for alcohol in oral fluid. About 25 % reported reduced efficiency at work, and 5 % reported absence from work due to alcohol use during the past 12 months. The use of illicit drugs and binge drinking resulting in reduced efficiency and absence was most common among restaurant and bar workers and more common among men than women, whereas use of psychoactive medication was most common among healthcare, transportation and storage workers.ConclusionImpairment at work due to alcohol or drugs was rare, whereas reduced efficiency due to drinking was reported by a fairly large proportion. There were marked differences between some business areas, and across gender.

Promoting HIV testing with home self-test kit among men who have sex with men in China: a feasibility study

BackgroundIn China, the prevalence of HIV infection is high among men who have sex with men (MSM), but the HIV testing rate is rather low. HIV and sexuality stigma are the main barriers faced by Chinese MSM to testing for HIV with available testing services. The aim of this study was to assess the accuracy and acceptability of oral-based home self-testing, which might address the issue. MethodThis two-stage interventional study of HIV testing at baseline and at follow-up took place in two big cities and involved 3 clinics in Beijing and Nanning. The study population is MSM in the previous year, 18 years or older, currently living in Beijing or Nanning. The two main recruitment methods were peer-referral and disseminating testing and survey information through internet. We collected data by asking participants to fill out a questionnaire, which covers demographic characteristics, behaviour characteristics, HIV testing history, willingness to use the oral fluid rapid HIV test, and test preference. The questionnaire was pretested among five MSM and modified according to the MSM's suggestion. We also sampled blood for HIV tests and monitored oral fluid rapid self-testing. Follow-up was in the 3–12 months range after baseline study. The diagnostic accuracy of oral fluid rapid test kit for HIV infection were measured with sensitivity, specificity, and conformity by comparing oral test results with blood tests for ELISA/Western blot. The blood tests was done after the oral fluid self testing at baseline. HIV-negative MSM at the baseline were recommended to use oral testing kits as HIV home test kits to repeatedly test for HIV between baseline and follow-up. Sample size was estimated with the formula of screening. All participants provided written informed consent for voluntary rapid oral fluid testing and/or blood testing, and participation in questionnaire interview. The study protocol and informed consent form was approved by the institutional review board of Guangxi Provincial Center for Disease Control and Prevention. FindingsBetween April, 2013, and April, 2014, we enrolled 510 MSM for baseline analysis, 279 of whom were available for follow-up. The sensitivity of oral fluid HIV self-testing at baseline was 86% (95% CI 81·09–95·62); and the specificity was 98·2% (97·88–98·52). 401 (79%) MSM at baseline were willing to test for HIV with oral fluid testing kits. The associated factors were no passive unprotected anal intercourse (UAI) with male partners in the past 6 months, active UAI with regular male partners in the past 6 months, and the first choice of being tested for HIV being an oral test. 176 (35%) MSM at baseline and 125 (40%) MSM at follow-up preferred oral HIV testing. The associated factors at baseline were to grow up in urban areas and willingness to self-test for HIV using oral test kit in future. 102 (25%) MSM were willing to purchase oral fluid test kit in the following 6 months. The associated factors were 25 years of age or younger, college-level or higher education, known HIV serostatus of non-regular male sex partners through testing, and the oral test being the first choice of test. InterpretationHome HIV self-testing using oral fluid rapid testing kit of high accuracy is promising to facilitate HIV testing among MSM in China. Self-testing with oral fluid self testing kits in our study was mainly in a supervised context and the researcher could provide on-site post counseling and refer to care immediately, hence lacking data on linkage into care following a positive HIV test. FundingGuangxi Provincial Center for Disease Prevention and Control.

Can “Oral Fluid” be Used Instead of “Urine” for Rapid Screening of Drug of Abuse: A Prospective Pilot Study

Introduction Spot urine tests are commonly employed by emergency physicians in Hong Kong to detect recent abusive drug exposure. Spot tests utilising oral fluid are gaining its popularity in other parts of the world. There was lack of evidence about employment of rapid oral fluid test (ROFT) in the local emergency medical settings. The objective of this study is to determine the operating characteristics of ROFT, and to compare its agreement with the bedside urine immunoassay test (BUIT). Setting The emergency department and the substance abuse clinic of a regional hospital. Methods This was a single-centered cross-sectional study of diagnostic test. Patients suspected to have drug abuse were tested using either one or both of the commercially available ROFT and BUIT. The sensitivity, specificity and accuracy of both tests were calculated with reference to the laboratory urine toxicology screening results. The agreement between ROFT and BUIT was calculated. Results For the detection of ketamine and methamphetamine (the two most prevalent abusive substances), ROFT had 72-100% sensitivity and 93-100% specificity, which were comparable to that of BUIT (74-100% sensitivity and 100% specificity). The overall observed agreement of ROFT and BUIT results was at least 96%. There was good agreement between ROFT and BUIT with kappa values of 0.90-1.00. Conclusion In this pilot study, the operating characteristics of ROFT are comparable with that of BUIT, with both tests showing good agreements in the detection of ketamine and methamphetamine uses. ROFT can potentially be employed as an alternative investigation for rapid diagnosis of patients with suspected drug abuse. (Hong Kong j.emerg.med. 2015;22:265-269)

Seroprevalence of IgG antibodies against vaccine-preventable diseases in newcomers to Luxembourg

No: 1510 Presentation at ESCV 2015: Poster 1 Seroprevalence of IgG antibodies against vaccine-preventable diseases in newcomers to Luxembourg J.M. Hubschen1,∗, E. Charpentier1, P. Weicherding2, C.P. Muller1 1 Department of Immunology, Luxembourg Institute of Health Laboratoire National de Sante, Esch-Sur-Alzette, Luxembourg 2 Direction de la Sante, Division Inspection Sanitaire, Luxembourg City, Luxembourg Background:Although the vaccine coverage of the general population in Luxembourg is above 90%, refugees or asylum seekers may be incompletely vaccinated and susceptible to vaccinepreventable diseases. Especially highly mobile traveller communities played an important role in the spreadof several infectious diseases in recent years. The prevalence of IgG antibodies against vaccinepreventable diseases among newcomers was investigated in order to prevent disease outbreaks in Luxembourg, also in the context of the 2015 WHO measles and rubella elimination goals. Methods:Serumandoral fluidwere collected from406 refugees or asylum seekers between 13 and 70 years from30 different countries, mainly belonging to the Balkans (87%), between May and September 2012. The serum samples were screened for IgG antibodies against the vaccine-preventable diseases measles, rubella, mumps, hepatitis B, tetanus, diphtheria and pertussis. Oral fluid sampleswere screened for antibodies againstmeasles, mumps and rubella virus to investigate whether oral fluid is a suitable alternative and non-invasive specimen for antibody prevalence studies. Results: More than 90% of the study participants had IgG antibodies against rubella,whileonlyabout73%and56%hadantibodies against measles and mumps, respectively. Less than 19% had protective antibodies against hepatitis B virus. Nearly 84% of the study participants had an adequate protection against tetanus, while the diphtheria results showed that for nearly 90% of the newcomers vaccination is recommended. Only about 40% of the study participants had antibodies against pertussis. Some differences according to origin, age and gender of the participants were observed. Based on the total IgG content, all 406 oral fluid samples were considered suitable for measles testing, 397 and 250 were included for rubella and mumps testing, respectively. 93%, 95% and 79% of the test results obtained with the two different specimens were concordant. Conclusion: The majority of the participants needed vaccination against measles/mumps/rubella (58%) and diphtheria/tetanus/pertussis (69%) as they were not protected against at least one of the diseases and against hepatitis B virus (82%). Since a good agreement between serum and oral fluid test results was observed, oral fluid is a suitable alternative and non-invasive specimen for measles and rubella antibody prevalence studies. http://dx.doi.org/10.1016/j.jcv.2015.07.080

An outbreak of hepatitis A virus associated with a multi-national inner-city nursery in Glasgow, Scotland

This report describes an outbreak of hepatitis A virus linked to a nursery which affected a total of 10 individuals. Active case finding, using oral fluid testing, helped identify asymptomatic cases. Nucleotide sequencing showed that all cases were caused by the same virus, which was most similar to HAV strains circulating Zimbabwe. Interestingly, an asymptomatic child had recently returned from visiting family in that country. Standard infection control procedures and vaccination of contacts successfully contained the outbreak. Only one patient developed hepatitis A despite having been vaccinated a week before symptoms began. This hepatitis A outbreak scenario may become more common as the numbers of international travellers and immigrants increase in the UK. It highlights the importance of recommending HAV vaccination to foreign nationals and their families who are travelling to countries endemic for hepatitis A.

(138) Modelling oral fluid test results for hydrocodone: assisting with assessment of dose compliance

Oral fluid testing to assist in the assessment of dose compliance for chronic pain patients is growing (1,2). This work reports a retrospective approach to determine the important parameters for assisting a clinician with assessing whether a patient is compliant or not with his or her prescribed dose of hydrocodone via oral fluid testing results. Data from patients who were both prescribed hydrocodone and tested positive (reporting cutoff < X < ULOL) by LC/MSMS were used to determine a “normal” representation of expected results. Patient demographic data was used to calculate the relevant parameters (e.g., blood volume) used in the transformations and normalizations. A logarithmic transformation of oral fluid test results for hydrocodone modified with patient specific parameters and daily dose levels followed by normalization to patient calculated blood volume results in a Gaussian distribution of these data. Treating patient results the same way allows for comparison with “normal” as defined by +/- 2 standard deviations from the adjusted mean of “0” standard deviations in the Gaussian distribution. While this comparison alone is not definitive for dose compliance, it can assist with the assessment of compliance together with patient interviews, prescription history, and other clinical criteria. The authors are employed by Ameritox, Ltd. Oral fluid testing to assist in the assessment of dose compliance for chronic pain patients is growing (1,2). This work reports a retrospective approach to determine the important parameters for assisting a clinician with assessing whether a patient is compliant or not with his or her prescribed dose of hydrocodone via oral fluid testing results. Data from patients who were both prescribed hydrocodone and tested positive (reporting cutoff < X < ULOL) by LC/MSMS were used to determine a “normal” representation of expected results. Patient demographic data was used to calculate the relevant parameters (e.g., blood volume) used in the transformations and normalizations. A logarithmic transformation of oral fluid test results for hydrocodone modified with patient specific parameters and daily dose levels followed by normalization to patient calculated blood volume results in a Gaussian distribution of these data. Treating patient results the same way allows for comparison with “normal” as defined by +/- 2 standard deviations from the adjusted mean of “0” standard deviations in the Gaussian distribution. While this comparison alone is not definitive for dose compliance, it can assist with the assessment of compliance together with patient interviews, prescription history, and other clinical criteria. The authors are employed by Ameritox, Ltd.

Roadside drug testing: Comparison of two legal approaches in Belgium

BackgroundInternationally, urine on-site testing has been used for detecting drivers under the influence of drugs (DUID) but more and more countries, such as Belgium, are switching to oral fluid screening. ObjectiveTo compare the previous (published in 1999) and current (published 2009) enforcement procedures of DUID in Belgium. The two evaluated procedures differ in the way the drivers are screened by the police (signs of impairment versus signs of recent drug use), the matrix for screening (urine versus oral fluid) and the analytical cut-off concentrations in plasma. MethodsData on positive screening and confirmation results were gathered from 1st April 2008 to 30th September 2010, when urine screening (Dipro Druglab panels test) was performed; and from 1st October 2010 to 31st March 2013, when an on-site oral fluid test (Securetec Drugwipe 5+) was used. ResultsApproximately 4100 data sets related to urine screening and 3900 data sets related to oral fluid screening were studied. Eighty-eight percent of positive urine on-site tests yielded positive results in plasma for cannabis, 21% for cocaine, 20% for amphetamines and 7% for opiates. Sixty-six percent of the positive oral fluid on-site tests yielded positive results in plasma for cannabis, 30% for cocaine, 28% for amphetamines and 8% for opiates. For cannabis, opiates and amphetamines more negative results in plasma were observed in the period of urine screening. ConclusionsThe percentage of plasma samples of tested drivers, in which none of the positive screened target drugs were present in a concentration above the legal cut-off value, has decreased from 17% to 8% since the introduction of the current legislation involving oral fluid screening.

Indirect competitive assays on DVD for direct multiplex detection of drugs of abuse in oral fluids.

On-site oral fluid testing for drugs of abuse has become prominent in order to take immediate administrative action in an enforcement process. Herein, we report a DVD technology-based indirect competitive immunoassay platform for the quantitative detection of drugs of abuse. A microfluidic approach was adapted to prepare multiplex immunoassays on a standard DVD-R, an unmodified multimode DVD/Blu-Ray drive to read signal, and a free disc-quality analysis software program to process the data. The DVD assay platform was successfully demonstrated for the simultaneous, quantitative detection of drug candidates (morphine and cocaine) in oral fluids with high selectivity. The detection limit achieved was as low as 1.0 ppb for morphine and 5.0 ppb for cocaine, comparable with that of standard mass spectrometry and ELISA methods.

Drug testing and adherence monitoring in pain management: Oral fluid testing.

A review of the utility of oral fluid in drug testing and adherence monitoring in pain management is presented. The article includes a description of the "State of the Art"; drug deposition; advantages and drawbacks of oral fluid testing; and overall related literature.

Oral fluid testing for pertussis, England and wales, june 2007-august 2009.

Existing pertussis surveillance systems tend to underidentify less severe cases among older children and adults. For routine follow-up of notified, nonconfirmed, clinically diagnosed pertussis cases, use of an oral fluid test was pilot tested in England and Wales during June 2007–August 2009. During that period, 1,852 cases of pertussis were confirmed by established laboratory methods and another 591 by oral fluid testing only. Although introduction of serologic testing in 2002 led to the greatest increase in ascertainment of pertussis, oral fluid testing increased laboratory ascertainment by 32% overall; maximal increase (124%) occurred among children 5–9 years of age. Patients whose pertussis was confirmed by oral fluid testing were least likely to be hospitalized, suggesting that milder community cases were being confirmed by this method. Oral fluid testing is an easily administered, noninvasive surveillance tool that could further our understanding of pertussis epidemiology and thereby contribute to decisions on vaccination strategies.

Introducing rapid oral-fluid HIV testing among high risk populations in Shandong, China: feasibility and challenges.

BackgroundThis study was conducted to ascertain the feasibility of using rapid oral fluid testing as an alternative HIV testing method in China.MethodThis is a mixed-method study among men who have sex with men (MSM), female sex workers (FSW) and VCT clients, conducted in 4 cities in Shandong Province. A pre-tested questionnaire was administered to 1137 participants through face-to-face interview to assess demographic characteristics, HIV testing histories and willingness to accept rapid oral fluid testing. VCT clients were provided with the saliva test kits for a screening test and errors in operation were recorded. Testing results were compared between oral and blood testing. Short feedback questionnaire was administered to 200 FSW who had undergone oral testing.ResultsThe rate of willingness to take oral-fluid HIV testing among MSM, FSW and VCT clients was 72.8%, 72.1% and 67.4% respectively. Common errors recorded during test kit operation by the 229 VCT clients included: unpreparedness, wrong swab sampling, wrong dilution, wrong testing and inability to read test results. Advantages of oral testing listed by participants included: less intrusive, painlessness, easy self- testing and privacy. Disadvantages included perceived unreliable results (55.5%) and not nationally recognised (9%). Comparison of saliva and the blood testing results recorded a consistency rate of 0.970 (χ2 = 153.348, P < 0.001), implying an excellent consistency.ConclusionIntroduction of oral rapid fluid testing as an alternative HIV testing method in China is highly feasible but with some challenges including low recognition and operation errors.

Use of a single alcohol screening question to identify other drug use

BackgroundPeople who consume unhealthy amounts of alcohol are more likely to use illicit drugs. We tested the ability of a screening test for unhealthy alcohol use to simultaneously detect drug use. MethodsAdult English speaking patients (n=286) were enrolled from a primary care waiting room. They were asked the screening question for unhealthy alcohol use “How many times in the past year have you had X or more drinks in a day?”, where X is 5 for men and 4 for women, and a response of one or more is considered positive. A standard diagnostic interview was used to determine current (past year) drug use or a drug use disorder (abuse or dependence). Oral fluid testing was also used to detect recent use of common drugs of abuse. ResultsThe single screening question for unhealthy alcohol use was 67.6% sensitive (95% confidence interval [CI], 50.2–82.0%) and 64.7% specific (95% CI, 58.4–70.6%) for the detection of a drug use disorder. It was similarly insensitive for drug use detected by oral fluid testing and/or self-report. ConclusionsAlthough a patient with a drug use disorder has twice the odds of screening positive for unhealthy alcohol use compared to one without a drug use disorder, suggesting patients who screen positive for alcohol should be asked about drug use, a single screening question for unhealthy alcohol use was not sensitive or specific for the detection of other drug use or drug use disorders in a sample of primary care patients.

Detection of 4 Benzodiazepines in Oral Fluid as Biomarker for Presence in Blood

Analysis of samples of oral fluid (mixed saliva) is increasingly being used to detect recent drug use. The aim of this investigation was to assess the suitability of testing oral fluid as a biomarker for the presence of 4 benzodiazepines in blood and its possible application in clinical settings and in research on drug use. Paired samples of oral fluid and blood from 4080 individuals in 4 European countries were collected and analyzed for benzodiazepines using gas or liquid chromatography with mass spectroscopic detection. Concentration data for the 4 most commonly detected benzodiazepines were studied: alprazolam, clonazepam, diazepam, and nordiazepam. Large variations in oral fluid to blood concentration ratios were observed for the studied benzodiazepines. The interquartile ranges for the oral fluid to blood concentrations ratios corresponded to 88%-197% of the median values. Selecting cutoff concentrations in oral fluid that gave the best accuracy in identifying individuals with benzodiazepine concentrations in blood above chosen thresholds produced accuracies of 74%-85% and the fraction of false negatives was 9%-23%. The concentration of the 4 studied benzodiazepines in oral fluid can neither be used to accurately estimate the concentrations in blood nor to correctly identify patients with blood drug concentrations below or above recommended therapeutic levels. When using analytical methods with limits of quantitation corresponding to concentrations less than 0.5 ng/mL in undiluted oral fluid, it may be used to confirm a recent intake of benzodiazepines. However, it is likely that some false negatives may occur.

Feedback on the management of the 2011 measles outbreak by French military general practitioners: An evaluation study

ObjectivePreventive measures were implemented in the French armed forces to limit the measles outbreak that occurred in 2010 and 2011. This study aimed to obtain feedback concerning the management of this outbreak by the French military general practitioners. MethodA cross-sectional study was conducted among the general practitioners (GPs) in military units located in metropolitan France. The 60 military units that reported at least one measles case in 2011 were included. Data were collected using self-administered questionnaires. ResultsThe acceptance of preventive measures against measles was good (measures “totally justified” for 77.8%) and most of the military GPs considered that the outbreak had no significant impact on their activities. The management of measles cases was perceived as not very problematic but difficulties were encountered in the identification of contacts around cases (48.1% of respondents) and in the identification of vaccine recipients among these contacts (more than 80% of respondents reporting difficulties in the collection of measles and vaccination histories). The organization of vaccination around cases was also perceived as difficult. ConclusionsPreventive measures around measles cases were well accepted by the military GPs, which could reflect their preparedness in the face of the outbreak. However, vaccination did not seem to be well understood or accepted by military patients, underlining the essential role of military GPs in patient information. Difficulties in the collection of vaccination and measles histories among contacts could be overcome by an early transcription of individual medical records in the military medical files of newly enlisted personnel. A more generalized use of oral fluid testing devices, which can be shipped at ambient temperature, would simplify diagnosis in the armed forces.

Acceptability and intended usage preferences for six HIV testing options among internet-using men who have sex with men

BackgroundMen who have sex with men (MSM) continue to be disproportionately impacted by the Human Immunodeficiency Virus (HIV) epidemic in the United States (US). Testing for HIV is the cornerstone of comprehensive prevention efforts and the gateway to early engagement of infected individuals in medical care. We sought to determine attitudes towards six different HIV testing modalities presented collectively to internet-using MSM and identify which options rank higher than others in terms of intended usage preference.MethodsBetween October and November 2012, we surveyed 973 HIV-negative or -unknown status MSM and assessed their acceptability of each of the following services hypothetically offered free of charge: Testing at a physician’s office; Individual voluntary counseling and testing (VCT); Couples’ HIV counseling and testing (CHCT); Expedited/express testing; Rapid home self-testing using an oral fluid test; Home dried blood spot (DBS) specimen self-collection for laboratory testing. Kruskal-Wallis tests were used to determine whether the stated likelihood of using each of these modalities differed by selected respondent characteristics. Men were also asked to rank these options in order of intended usage preference, and consensual rankings were determined using the modified Borda count (MBC) method.ResultsMost participants reported being extremely likely or somewhat likely to use all HIV testing modalities except DBS self-collection for laboratory testing. Younger MSM indicated greater acceptability for expedited/express testing (P < 0.001), and MSM with lower educational levels reported being more likely to use CHCT (P < 0.001). Non-Hispanic black MSM indicated lower acceptability for VCT (P < 0.001). Rapid home self-testing using an oral fluid test and testing at a physician’s office were the two most preferred options across all demographic and behavioral strata.ConclusionsNovel approaches to increase the frequency of HIV testing among US MSM are urgently needed. Combination testing packages could enable high risk MSM in putting together annual testing strategies personalized to their circumstances, and warrant due consideration as an element of combination HIV prevention packages.

Rapid Oral Fluid HIV Antibody Testing in Exposed Babies: A Diagnostic Study

Aims: The usefulness of rapid oral fluid HIV antibody tests has rarely been evaluated in exposed babies. Study Design: A diagnostic survey comparing the performance of oral fluid HIV antibody test and the routine rapid blood screening test. Place and Duration of Study: University College Hospital, Ibadan and Nigerian Institute of Medical Research, Lagos, between May 2010 and April 2011. Methodology: The study involved children aged less than 18 months referred for screening in two large HIV care programmes in Nigeria using rapid antibody tests - an oral fluid test (Test A) and the routine blood test (Test B). The testing was blinded and HIV status was confirmed using DNA PCR. Results: A total of 94 children were studied with ages ranging from 0.13 to less than 18months. Out of the 94 parallel tests, when compared with DNA PCR, there were 7 (7.5%) discordant results. Test A gave one false positive, one false negative and no indeterminate result. Test B gave four false positive, one false negative and two indeterminate results. Test A had a sensitivity of 93.3%, specificity of 98.7%, positive

Medicolegal Aspects of Cannabis and Its Metabolites Detection Window in Oral Fluid And Urine

Cannabis is one of the most widely used illicit drugs. Oral fluid substance use testing is increasing and has many advantages over urine testing especially for recent substance use diagnosis. The aim of this study was to establish the possibility of detection of recent cannabis smoking through oral fluid and urine testing and its medicolegal aspects. Forty subjects were asked to provide oral fluid and urine samples after a reported period of abstinence. They provided 167 oral fluid samples during abstinence over 5 min – 30 h and 206 urine samples during extended observed abstinence over 1 - 90 days. Cannabis was detected using One Step cannabinoid urine test. The first negative oral fluid sample was that obtained 22 – 30 h after abstinence while the first negative urine sample was detected after seven days of abstinence. Cannabis was detected in urine samples for up to 70 days. These data suggest that oral fluid can be used to discriminate recent from former cannabis use indicating that the user is under the effect of cannabis.