Acute Infection Screening and Prevention (AISAP) Pat Simmons Florida Department of Health Division of Disease Control Bureau of HIV/AIDS Early Intervention Program Counseling and Testing Section

AREA 1 ESCAMBIA OKALOOSA SANTA ROSA WALTON AREA 2 BAY CALHOUN FRANKILIN GADSDEN GULF HOLMES JACKSON JEFFERSON LEON LIBERTY MADISON TAYLOR WAKULLA WASHINGTON AREA 3 ALACHUA BRADFORD COLUMBIA DIXIE GILCHRIST HAMILTON LAFAYETTE LEVY PUTNAM SUWANNEE UNION AREA 4 BAKER CLAY DUVAL NASSAU ST JOHNS AREA 5 PASCO PINELLAS AREA 6 HILLSBOROUGH MANATEE AREA 7 BREVARD ORANGE OSCEOLA SEMINOLE AREA 8 CHARLOTTE COLLIER DESOTO GLADES HENDRY LEE SARASOTA AREA 9 PALM BEACH AREA 10 BROWARD AREA 11 DADE MONROE AREA 12 FLAGLER VOLUSIA AREA 13 CITRUS HERNANDO LAKE MARION SUMTER AREA 14 HARDEE HIGHLANDS POLK AREA 15 INDIAN RIVER MARTIN OKEECHOBEE ST LUCIE Florida AISAP Study Counties ESCAMBIA SANTA ROSA OKALOOSA WALTON HOLMES WASHINGTON BAY JACKSON CALHOUN GULF LIBERTY FRANKLIN GADSDEN LEON WAKULLA JEFFERSON TAYLOR MADISON HAMILTON SUWANNEE LAFAYETTE DIXIE LEVY GILCHRIST COLUMBIA ALACHUA UNION BRADFRD NASSAU MARION CITRUS HERNADO PASCO SUMTER LAKE PUTNAM CLAY BAKER DUVAL ST JOHNS FLAGLER VOLUSIA SEMINOLE ORANGE BREVARD OSCEOLA POLK HILLSBOROUGH PINELLAS MANATEE HARDEE DESOTO CHARLOTTE LEE GLADES HENDRY COLLIER MONROE DADE BROWARD PALM BEACH MARTIN ST LUCIE OKEECHOBEE INDIAN RIVER HIGHLANDS SARASOTA Duval, Hillsborough, Pinellas, Orange

Florida discovered: Use the best plasma collection tubes Ensure specimen integrity Incorporate negative rapids with NAAT Designate an AHI DIS or CTL person If possible, target NAAT for high risk Be aware of client ART history

The Sites and DIS: Collect, spin, ship Respond before lab result is mailed Contact client as quickly as possible Initiate field records Confirmation draw The Lab: Antibody screening Pooling or individual NAAT Viral loads Report out as quickly as possible Collecting, Testing, Imparting, and Confirming

AHI and the DIS Call DIS Explain test results to clients Linkage or referral to services Partner Services Pull confirmatory sample Obtain follow-up appointment

ClientResults1 st VL2 nd VL P1EIA - NAAT +1,381,600916,500 P2EIA + WB I NAAT +6,334,40021,856 P5EIA + WB - NAAT +138,126UTL P6EIA - NAAT +241,5471,204,000 P7EIA - NAAT+8,70015,900 P8EIA - NAAT+204,10053,100 P10EIA + WB I NAAT +1,024,000101,300 P11EIA - NAAT +9,9003,436 P12EIA + WB I NAAT +47,70092,900 P14EIA + WB - NAAT +3,397,400Anonymous P15RT – NAAT +111,127Pending

Total of 14 AHI Results 11 of which were true AHI 8 Seroconverted antibody positive 3 False positive NAAT 1 Pending redraw 1 Unable to locate 1 Anonymous – Unable to locate

False NAAT Impact 3 false positive NAAT 2 before lab rectified 1 after lab rectified 2 pregnant 1 non-English speaker NAAT post-test counseling: Shock, denial, lots of questions, partners cooperative Negative serostatus post-test counseling: Lots of questions, willing to test for other STDs

AHI Snapshots Client did not want to receive seroconversion results, STD Hx, has tested again Client has alias names and addresses, STD and drug use Hx Client was discovered as a part of a syphilis cluster investigation Client is homeless, MH issues, lack of HIV knowledge, took several DIS to locate

RT Negative Client TestResult (10/11)Result (10/17) OraQuick Finger stick Non-Reactive EIAN/ANegative WBN/AAll bands negative NAATNAPositive VLN/A111,127

AHI Partner Services 29% not located (4) 71% located (10) 70% were tested (7) 43% new HIV positives (3) 29% new HIV negatives (2) 29% repeat negatives (2)

EIA / NAAT “Discordants” 1 st client positive since mid 1990’s and does not claim any ART 11 th client initial indeterminate / NAAT negative; follow up concordant (positive) after two draws

First EIA / NAAT “Discordant” TestResult (5/1)Result (5/24) EIARR WBp24, p31, gp160 p24, gp160 NAATNegative RTOraQuick Pos Multispot Pos N/A VLN/A<75 CD4 CD8 Ratio N/A2.54

False NAAT Negative TestResult (9/22)Result (10/18)Result (10/25) EIARR WBp24p24, p41, p120, p160 P24, p41 I, p120 I, p160 NAATNegativeUnsatisfactoryPositive

Lessons Learned Sites must fully understand AHI Budgets need to sustain AHI detection DIS staffing must be sufficient Provide access to services for AHI ART history may yield a NAAT negative Reduce unsats

If Florida were to do this again, say in the Miami/Dade area….. …what would be done differently? Focus on Acute Infections Assign a coordinator within Miami-Dade Obtain a strong STD partnership Include negative rapids and mobile units

Bureau of Laboratories Berry Bennett Sally Fordan Olanike David Petirce Stephens Bureaus of HIV/AIDS and STD Marlene LaLota Pat Simmons Melinda Waters Dan Pope Robert Chen Dan George Stacy Shiver CDC Pragna Patel Duncan Mackellar Patrick Sullivan Steven Ethridge Michele Owen Walid Heneine Clyde Hart Angela Hutchinson Stephanie Sansom Paul Farnham It takes a village…