2. Alere HIV Diagnostic Care; Solutions to Fast Track 90-90-90
Value of Earlier Case Findings using
Alere™ HIV Combo in a Community Setting
Michael Meulbroek
Projecte dels NOMS-Hispanosida
Alere HIV Diagnostic Care;
Solutions to Fast Track
Paris, 25 July 2017

3. Introduction
2007 UNAIDS Global Campaign “ Know Your Epidemic, Know Your Response”.

4. Europe

5. The HIV epidemic is concentrated in the cities
UNAIDS gap report 2015

6. Opening of BCN Checkpoint
BCN Checkpoint opened in January 2006
A community center for gay men, other men who have sex with men and transgender women
Situated in the middle of Barcelona’s gay area
Service is free, anonymous and confidential
Peer counselors: all are gay and most are HIV+
BCN Checkpoint introduced the use of HIV rapid tests in community centers in Europe in 2006

7. Introduction of HIV Rapid Test in a non-clinical setting (2006)
To reduce high number of persons that doesn’t come back for the result of an HIV test
Acceptability test
93.2% important to obtain result in 30 minutes
97.7% positive opinion to offer rapid test in a community center
Specific training for counselors
Informed consent:
Counselor is a peer
Positive result needs confirmation

8. Results of the introduction of HIV Rapid Testing in non-clinical settings

9. Number of tests and clients in BCN Checkpoint (2006 - 2016)
7,737
5,542
3,837
3,198

10. Positive results and rate (2006 - 2016)
172
146
132 37

11. Impact of BCN Checkpoint
Source: Actualizació a 06/10/2016. Vigilància epidemiològica de la infecció pel VIH i la SIDA a Catalunya. Ceeiscat. Departament de Salut. Generalitat de Catalunya

12. Linkage to Care

13. Need to detect HIV infections earlier
New HIV
Infections

14. Early phases of HIV infection

15. Transmission risk acute infections
Blood viral load in acute HIV (n=171) Average fitted curve, with 95% confidence intervals
log 10 HIV RNA 8 7 6 5 4 3 2 1
8-10 fold increase risk from peak to day 54
300
200
100
Days from Infection
Peak: day 23
Pilcher, et al JID 2004

16. Challenges to find earlier HIV infections
Recommend and promote regular testing in key populations

17. Campaign for more frequent testing (2014)

18. Campaign for more frequent testing (2015)
Gay men
do it often!

19. Campaign for more frequent testing (2016)

20. Challenges to find earlier HIV infections
Recommend and promote regular testing in key populations
Use P24 antigen in usual screening in key populations
Alere™ HIV Combo

21. Detection of P24 antigen before antibodies
Acute
Seroconversion→Established
Das G et al. BMJ 2010;341:bmj.c4583

22. Test, detect and start treatment
Kroon EDMB et al. Journal of the International AIDS Society 2017, 20:21708
Published 28 June 2017

23. Detection of P24 antigen Introduction Alere™ HIV Combo: 25 March 2016
Period: 25 March 2016 – 31 December 2016
Total tests performed: 5,800
Total persons tested: 4,485
Total reactive tests: 113
antibodies
P24 and antibodies
P24
Total
Total reactive tests
106 3 4
113
False positive results 5 1 6
Confirmed positive results
101
107
+ 2.9%
+ 5.9%

24. Time to start treatment
Added value detection of P24 antigen
Cases
Age
Marker
Time to hospital
Time to start treatment
VL (millions)
CD4
Nº 1 35
P24
1 day
same day
> 10
257
Nº 2 46
332
Nº 3 60
2 days
4.60
385
Nº 4 45
P24 and antibodies
16 days
0.57
301
Nº 5 22
12 days
3 days
0.27
144
Nº 6 28
5 days
0.24
238

25. Results
Resource: results BCN Checkpoint

26. Results Early Detection + Fast Linkage to Care + Treatment
Source: Agència de Salur Pública. La Salut a Barcelona Published: December 2016

27. Detección infecciones agudas en BCN Checkpoint
Late diagnostics
Detección infecciones agudas en BCN Checkpoint
Alere Pima™
Point-of-Care CD4 test

28. Summary
In Europe the HIV epidemic concentrates mostly in MSM and other key populations and in urban areas.
MSM need a specific action plan that includes targeting testing and linkage to care, increase testing frequency and screening for acute infections.
Community centers has shown to be effective with the use of POCT in key populations. However, if we want to reduce the gap in the first step of the continuum of care HIV infections should be found in the earliest phases in order to reduce the ongoing transmission chain.
The use of Alere™ HIV Combo in BCN Checkpoint permits a general screening to all clients for early HIV infections.
Results from 2016 show that at least 2.9% more cases were found where standard antibody tests would have been a missed opportunity.
Moreover, cases with only P24 antigen had a significant higher viral load, hence detection in this phase of infection saves 8-10 times more onwards infections and is an important tool for reaching the goals.

29. Acknowledgements