Acceptability of Acute HIV Infection Screening at STD Clinics that Utilize Rapid HIV Screening Tests, New York City, 2007

Background:
Beginning in 2006, the NYC Department of Health and Mental Hygiene (DOHMH) partnered with the Centers for Disease Control and Prevention (CDC), in a multi-site research study examining the impact and acceptability of pooled HIV-1 RNA nucleic acid amplification testing (HIV-NAAT) for detection of acute HIV infection (AHI).

Objective:
To measure the acceptability of HIV-NAAT.

Method:
Individuals ≥18-years seeking a confidential HIV test at 3 participating NYCDOHMH clinics were offered HIV-NAAT. Acceptability was determined by whether or not an eligible person provided written consent and had blood tested. Bivariate analyses examined acceptability among groups defined by sex, race/ethnicity, age and sexual behavior (based on sex of partner in 3 months prior to testing).

Result:
From June-August 2007 among eligible persons (N=3898), testing was accepted by 59% (2305/3898). A larger proportion of women accepted testing 63% (963/1531) than men 57% (1341/2364), African Americans 64% (1232/1915) than Caucasians 41% (307/750), Hispanics 69% (611/898) than non-Hispanics 57% (1677/2966), lesbians 63% (69/102) than MSM 51% (227/444), and persons 41-50 years-old (62%; 243/390) compared to other ages. Those tested (N=2305) were mostly male (58%; 1341/2305), African American (53%; 1232/2305), 21-30 years-old (52%; 1189/2305) and heterosexual (88%; 2036/2305). Men-who-have-sex-with-men (MSM) accounted for 10% of all participants. Two cases of AHI were diagnosed; both were white, MSM and 21-30 years-old.

Conclusion:
Acceptability of HIV-NAAT is lower than expected. Possible explanations for this include 1) testing is offered as part of a research study and involves signing a separate consent 2) anxiety of waiting 5-7 days for test result, 3) longer pre/post test counseling sessions to cover AHI information.

Implications:
Diagnosing AHI can curtail transmission of HIV, as AHI-infected persons are usually unaware of infection and highly infectious. Strategies should be devised to surmount barriers to acceptance of HIV-NAAT, especially among persons at increased risk for HIV.