Implementing Rapid HIV Testing in Non-traditional Sites

1
Implementing Rapid HIV Testing
in Non-traditional Sites  
Gratian Salaru, M.D.1, Evan M. Cadoff, M.D.1,
Sindy M. Paul, M.D.2, Vivian H. Shih, BA1,
Dolores Van Pelt, BSN1, Nisha J. Intwala, BS
(MT)1, Franchesca N. Jackson, BS1, Sharon A.
Holswade, M.B.A.1, Eugene G. MARTIN, Ph.D.1 1
UMDNJ-Robert Wood Johnson Medical School, New
Brunswick, NJ, 2 New Jersey Department of
Health and Senior Services, Trenton, NJ.
Results
Abstract
Background Efforts to control HIV spread have
been frustrated by difficulties reaching
high-risk populations. In 2003, we began
training, certification and licensure to permit
counselors at 23 organizations in New Jersey to
offer rapid HIV testing. To improve the
proportion of high-risk populations testing for
HIV and to increase the proportion of people who
learn their test result, satellite facilities
were added starting in 2004, and in May 2005,
testing began in several non-traditional sites,
including mobile vehicles. Methods Vehicle
modifications and the development of support
materials allow rapid HIV testing to be offered
successfully in non-traditional formats. Vehicles
ranging from minivans to RVs were reconfigured to
provide secure, confidential testing environments
that effectively extend the boundaries of primary
locations. Quality assurance measures, including
a centralized core technical staff with uniform
personnel and procedures, policies and forms,
were critical to success. To minimize quality
control costs, procedures and equipment were
tailored to specific needs. Thermal carriers
utilizing phase-shift materials and electronic
temperature monitoring established a reliable
storage environment. Specialized LED flashlights
provided consistent illumination. Results As of
December 31, 2005, ten mobile units were
operational in previously underserved areas,
performing more than 1,100 tests with 17 (1.5)
preliminary positive results. Over 99 of those
tested received their results. No discordants
were identified in testing obtained on these
units.

• As of December 31, 2005, ten mobile units were
  licensed
• operational territory in previously underserved
  areas
• performed more than 1,100 tests
• 17 (1.5) preliminary positive results
• no discordant results were reported (preliminary
  positives not confirmed by Western Blot test).
• As of July 31, 2006, an additional eight mobile
  units were licensed and
• operational, bringing the grand total of
  non-traditional sites to 18.
• Data collected from the RWJ coordinated sites
  (and extracted from
• the travel logs provided to the sites) show that
  for the period of
• January to June 2006
• 18 mobile units were functional under RWJ
  coordinating efforts
• a total of 1734 tests were performed, out of
  which 1182 were oral mucosal transudate and 552
  were fingersticks
• 26 preliminary positives were identified ( 1.49)
• 3 discordant results were reported (0.17)
• 428 controls were run (19 of total test kits
  used)
• While the positive rates have remained about the
  same, the testing

• Changes in forms and protocols were made to
  assure that
• testing kits were stored in adequate conditions
• the transport of the kits and controls was
  performed in a standardized, controlled fashion
• no testing kits were subjected to more than 3
  out of the main site travels, to minimize
  potential impact of thermal stress on the devices
• inventory control was maintained
• accurate testing volumes, patient identifiers,
  lot numbers for both device and controls used,
  temperatures in the storage and testing area and
  type of testing (oral vs. fingerstick) were
  recorded
• testing logs were analyzed centrally at the core
  facility and changes in inventory or quality
  control issues were addressed immediately and
  efficiently.

Background
Conclusions

• Rapid HIV testing has been successfully
  implemented in a variety of non-traditional
  formats.
• In particular, mobile testing sites are able to
  provide rapid HIV testing to persons who may not
  go to a traditional stationary site.
• The increase in testing volumes is significant
  and may represent increased acceptance of these
  non-traditional testing units by the population.

References

• Centers for Disease Control and Prevention.
  HIV/AIDS Surveillance Report 2002.
  http//www.cdc.gov/hiv/stats/addendum.htm
• Centers for Disease Control and Prevention.
  Incorporating HIV Prevention into the Medical
  Care of Persons Living with HIV Recommendations
  of CDC, the Health Resources and Services
  Administration, the National Institutes of
  Health, and the HIV Medicine Association of the
  Infectious Diseases Society of America. MMWR
  2003 July 18 52(RR12)1-24.
• Centers for Disease Control and Prevention.
  Number of persons tested for HIV United States,
  2002. MMWR 2004 December 3 531110-1113.
• Truong, H-H M and Klausenr JD. Diagnostic Assays
  for HIV-1 infection. MLO 200436 no. 7 12-20.
• Centers for Disease Control and Prevention.
   Updated U.S. Public Health Service Guidelines
  for the Management of Occupational Exposures to
  HIV and Recommendations for Postexposure
  Prophylaxis.  MMWR 2005 September
  3054(RR09)1-17.

Acknowledgements
DHHS, HIV/AIDS Division staff, entire NJHIV
support staff and NJ HIV counselors for their
tireless work and effort in fighting HIV in New
Jersey For additional facts about NJHIV program,
visit www.njhiv.org