BCN Checkpoint: same‐day confirmation of reactive HIV rapid test with Point Of Care HIV‐RNA accelerates linkage to care and reduces anxiety

Abstract

Background The introduction in 2006 of the rapid HIV test by BCN Checkpoint in a non‐clinical setting has been a successful step forwards in the uptake of testing. Nevertheless, HIV serostatus should be reported as HIV positive only when a reactive result has been tested again using a different assay (WHO guidelines 2015). The standard confirmation test has been the Western Blot (WB) test. However confirmation results take around 7 days to come back. Aims This study explores the possibility of Point of Care PCR testing for a same‐day confirmation. Materials and Methods Between March 2015 and September 2016 a POC PCR test (Xpert® HIV‐1 Qual) was performed in parallel to the Western Blot test after a reactive HIV rapid test (Alere Determine™ HIV‐1/2 Ag/Ab Combo and Alere™ HIV Combo). HIV confirmed positive cases received emotional support by peers, were informed and prepared for treatment initiation and rapidly linked to HIV clinic. Results During the study period 11 455 tests were performed to 7163 clients. A total of 249 reactive rapid HIV tests were found. For analysis a total of 33 cases were excluded due to the lack of PCR and/or WB test. Results of comparison of the 216 cases showed 194 concordant positive confirmations and 14 concordant negative results. In three cases PCR was positive and WB negative. In five cases PCR was negative and WB positive. Conclusion The POC PCR assay is easy to use and feasible in a community‐based center. Reducing time for confirmation to 90 min has been possible in 91.2% (197/216) of cases with positive PCR result. In cases of a negative PCR result an additional test (WB, Elisa or PCR quantitative) was needed to distinguish false positive results (6.5%) from viral load results below level of detection (2.3%). Clients expressed satisfaction with same‐day confirmation and less anxiety.

Point-of-Care HIV Viral Load Testing: an Essential Tool for a Sustainable Global HIV/AIDS Response

“…The proportion of HIV-positive infants who were initiated on ART by 60 days increased from 43.3% to 92.3%, with cost per result returned in 30 days decreasing from $131 (U.S. dollars) with conventional referral laboratory testing to $38 with POC testing. In a study for diagnosing acute HIV infection, 91% of the patients attending a community clinic in Spain were notified of their HIV-positive status the same day using the Xpert HIV-1 Qual assay (126). These studies demonstrate that POC platforms can be successfully implemented in a number of settings and have led to guidelines for the introduction of HIV POC diagnostics into national programs (127).…”

HIV testing strategies outside of health care settings in the European Union (EU)/European Economic Area (EEA): a systematic review to inform European Centre for Disease Prevention and Control guidance

“…Twenty studies provided non‐targeted testing to the general population, while 44 studies provided testing to one or more groups at higher risk of HIV infection. MSM were the group most frequently targeted ( n = 31) , followed by: migrants ( n = 10) , people who use/inject drugs (PWUD/PWID) ( n = 8) , SWs ( n = 7) , black and minority ethnic groups (BME) ( n = 5) , young people ( n = 4) , homeless people ( n = 3) , and other key risk populations not specified ( n = 3) .…”

“…An overview of these 80 studies can be found in Table . Studies were from 14 of the 30 countries in the EU/EEA, with most set in Northern Europe ( n = 37), followed by Southern Europe ( n = 27) and Western Europe ( n = 12).…”

“…Of the 65 studies that introduced HIV testing, 56 studies utilized novel HIV testing technologies to improve testing uptake [18,19,[21][22][23][25][26][27]29,[31][32][33][34][35][36][37][38][39][41][42][43]46,47,[50][51][52]54,[58][59][60][61][62][64][65][66][67][68][69][72][73][74][75][76][77][78]81,83,84,[86][87][88][89]…”

“…Twenty studies provided non-targeted testing to the general population, while 44 studies provided testing to one or more groups at higher risk of HIV infection. MSM were the group most frequently targeted (n = 31) [20,21,[25][26][27]30,32,38,39,46,51,54,58,60,61,[63][64][65][66][72][73][74]76,77,81,86,87,89,94,96,97], followed by: migrants (n = 10) [21,33,52,59,61,74,86,87,89,97], people who use/inject drugs (PWUD/PWID) (n = 8) [33,36,49,61,81,86,87,89], SWs (n = 7)…”