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Background: Identifying acute HIV infection (AHI) is important, because it is a period of high infectivity. In high volume, limited resource settings, such as public STD clinics, AHI is detected by pooled nucleic acid amplification testing (pNAAT). Whether specimens from all patients or only selected patients should undergo pNAAT is unknown.
Objectives: Compare the impact of using targeted versus universal AHI screening in NYC STD clinics.
Methods: Using medical record data, we identified risk factors for AHI among cases diagnosed in nine NYC STD clinics. We then developed criteria for targeted AHI screening, and compared yields and costs pre- and post- implementation.
Results: From January 2009 through May 2010, 91,591 antibody negative specimens were screened by pNAAT, yielding 50 AHI cases (5.5 cases/10,000 specimens); 40/50 (80%) were men who have sex with men (MSM); 78% were people of color and 48% were previously diagnosed with an STD. In June 2010, we restricted AHI screening to patients reporting any of the following: MSM, sex with MSM, sexual exposure to HIV, sex with injection drug user, exchanging sex for money or drugs, sharing injection equipment, or recent sexual assault. From June 2010 through August 2011, 12,527 targeted specimens were screened by pNAAT, yielding 43 cases (34.3 cases/10,000 specimens), representing an 86% decrease in testing volume compared to universal screening; 42/43 (98%) were MSM; 77% were people of color and 65% were previously diagnosed with STD. The number needed to test to find one AHI case was reduced from 1,832 to 268 and average cost per case identified reduced from $16,702 to $2,554 as a result of targeting efforts.
Conclusions: By deriving criteria for patients at high risk of AHI, we improved the yield of AHI testing and contained costs compared to screening all HIV antibody test negative specimens for AHI.
Implications for Programs, Policy, and Research: In an STD clinic population, targeted screening effectively and economically identifies patients with AHI.