1. Bernard M. Branson, M.D. Associate Director for Laboratory Diagnostics Divisions of HIV/AIDS Prevention National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Centers for Disease Control and Prevention HIV Testing and Considerations for Prevention

2. Percent of Persons Ever Tested and Tested in the Preceding 12 Months - NHIS 2002-2006 - MMWR August 8, 2008

3. Early Indications of Progress: National Health Interview Survey Ever TestedLast 12 months 2005 70,036,336 (39.9%) 18,042,610 (10.44%) 2006 71,468,420 (40.4%) 17,775,006 (10.39%) 2007 73,848,002 (41.3%) 18,791,895 (10.67%) 2008 80,172,602 (44.6%) 19,055,402 (10.74%) Change since 2006: 8.7 million1.3 million Source: National Health Interview Survey

4. Estimated Cases of HIV/AIDS, by year of diagnosis (based on 34 States with Confidential HIV Reporting) 200437,164 200536,640 200637,193 2007 Change: 42,655 5462 (15%) Source: HIV/AIDS Surveillance Report, 2007

5. CDC’s Expanded Testing Initiative Test 1.5 million persons per year among populations disproportionately affected by HIV, primarily African-Americans. Identify 20,000 new HIV infections Funded September 2007

6. Progress: Total Tests Cumulative TestsAvg Tests/Month Oct-Mar 200887,03814,506 Apr-Sept 2008446,50337,209 Oct – Mar 2009859,88247,771 April 2009932,15749,061 May 20091,027,05951,353 June 20091,136,06754,098 July 20091,221,68055,531

7. Percentage of Tests and New HIV+ Tests by Venue, Sept 2007 through March 2009 Total TestsHIV+ Tests

13. HIV Testing Among IDU  HIV Testing Survey, 1998-1999 90% previously tested  5 cities, 1998 – 2002 * 93% previously tested 69% tested within previous year - Kellerman et el, JAIDS 2002 - Heimer et al, AJPH 2007 *Chicago IL, Hartford CT, New Haven CT, Oakland CA, Springfield MA

14. HIV Testing Among MSM  Young MSM study, 1998-2000 88% previously tested, 54% in previous year  National HIV Behavioral Surveillance 2003-2005: 92% previously tested, 77% in previous year  57,131 MSM visits to STD clinics, Denver, DC, San Francisco, Seattle 94% previously tested Median inter-test interval 243 days - MacKellar et al, Sex Transm Diseases 2006 - CDC, MMWR Surveillance Summaries 2006 -Helms et al, JAIDS 2009

15. Total Tested HIV Prevalence No. % Unrecognized HIV Infection No. % Age Group (yrs) 18-24410 57(14)45(79) 25-29303 53(17)37(70) 30-39585171(29)83(49) 40-49367137(37)41(30) ≥ 50102 32(31)11(34) Race/Ethnicity White616127(21)23(18) Black444206(46)139(67) Hispanic466 80(17)38(48) Multiracial 86 16(19) 8(50) Other139 18(13) 9(50) Total1,767450(25)217(48) HIV Prevalence and Proportion of Unrecognized HIV Infection Among 1,767 MSM, by Age Group and Race/Ethnicity NHBS, Baltimore, LA, Miami, NYC, San Francisco MMWR June 24, 2005

19. Pooled RNA Screening for Acute HIV Infection

20. 1 Master Pool 1-Stage Pooling 16 Specimens A B C D E F G H I J CDC Acute HIV Infection Study K L M N O P

21. Yield from Pooled RNA Screening after EIA Site Number tested HIV Ab+ RNA+/ Ab- Florida – 2006-0854,948663 (1.2%) † 9 (0.02%) L.A. - 2006-0837,012427 (1.2%)* 35 (0.09%) † Screened with Bio-Rad 1-2 Plus O *Screened with Vironostika EIA - Patel et al, CDC, Archives Int Med 2010

22. Yield from Pooled RNA Screening after EIA Site Number tested HIV Ab+ RNA+/ Ab- Florida – 2006-0854,948663 (1.2%) † 9 (0.02%) L.A. - 2006-0837,012427 (1.2%)* 35 (0.09%) L.A. - 2006-0837,012441 (1.2%) † 18 (0.05%) † Screened with Bio-Rad 1-2 Plus O *Screened with Vironostika EIA - Patel et al, CDC, Archives Int Med 2010

23. Yield from Pooled RNA Screening after Rapid Test Site Number tested HIV Ab+ RNA+/ Ab- Florida60417 (2.8%)1 (0.2%) New York6,54729 (0.4%) 7 (0.1%) - Patel et al, CDC, Archives Int Med 2010

24. Yield from Pooled RNA Screening after Rapid Test Site Number tested HIV Ab+ RNA+/ Ab- Florida60417 (2.8%)*1 (0.2%) Florida60417 (2.8%) † 1 (0.2%) New York6,54729 (0.4%)* 7 (0.1%) New York6,54735 (0.5%) † 1 (0.02%) * Screened with OraQuick † Screened with BioRad 1-2 Plus O - Patel et al, CDC, Archives Int Med 2010

25. Acute HIV Screening: 99,111 tested EIA-RR/WB+1,136 (1.1%) NAAT+ 1,094 (96.3%) NAAT- 42 (3.7%) EIA-RR/WB-ind30 (0.03%) NAAT+ 3 (10.0%) NAAT- 27 (90.0%) EIA-neg/NAAT+52 (0.05%) Acute HIV 48 (92%) False-pos NAAT 4 (8%) - Patel et al, Archives Int Med 2010

26. Acute HIV Screening: 99,111 tested EIA-RR/WB+1,136 (1.1%) NAAT+ 1,094 (96.3%) NAAT- 42 (3.7%) EIA-RR/WB-ind30 (0.03%) NAAT+ 3 (10.0%) NAAT- 27 (90.0%) EIA-neg/NAAT+52 (0.05%) Acute HIV 48 (92%) False-pos NAAT 4 (8%) - Patel et al, Archives Int Med 2010

27. Acute HIV Screening: 99,111 tested EIA-RR/WB+1,136 (1.1%) NAAT+ 1,094 (96.3%) NAAT- 42 (3.7%) EIA-RR/WB-ind30 (0.03%) NAAT+ 3 (10.0%) NAAT- 27 (90.0%) EIA-neg/NAAT+52 (0.05%) Acute HIV 48 (92%) False-pos NAAT 4 (8%) - Patel et al, Archives Int Med 2010

28. Acute Infections in MSM detected by NAAT  0.3% of 14,005 frequently tested MSM in Seattle STD clinic; represent 20% of all HIV infections detected  26 (74%) of 35 AHI cases detected in LA at MSM clinic; 25% of all HIV infections detected  0.08% of 21,425 STD clinic patients in New York City; represent 9% of all HIV infections detected; 94% were MSM - Stekler et al, Clin Infect Dis 2009 - Shepard et al, MMWR 2009 - Patel et al, Archives Int Med 2010

29. 4 th Generation vs. RNA  RNA+/ 3 rd gen-negative specimens detected by 4 th generation EIA: 38 of 46 (83%) – Australia* 10 of 14 (71%) – CDC AHI study** 51 of 61 (84%) – CDC panel*** 4 days after RNA – 9 seroconversion panels*** * Cunningham P, HIV Diagnostics Conf 2007 ** Patel P, CROI 2009 *** Owen M, CROI 2009

30. Potential Prevention Research Questions  Indications for and frequency of retesting  Role of acute infection in sustaining the epidemic  Community trial of structured serosorting intervention