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Background: Newer generation EIA and PCR tests can increase the yield of HIV case-finding but little is known about their utility in community-based, anonymous testing settings.
Objectives: To describe the contribution of enhanced screening for identification of acute HIV infection in a high volume, anonymous HIV testing clinic.
Methods: Patients were screened on-site using HIV rapid tests. Sera were screened with 3rd generation EIA if rapid test negative. EIA- specimens were PCR tested using a 36 specimen pooling algorithm; EIA+/WB- specimens were PCR tested individually. Patients opted to provide contact information (phone number or email) for notification if additional screening results were positive/inconclusive.
Results: From January 2009 – July 2011, two hundred forty (240) new HIV infections from 10,962 rapid tests were identified, yielding a positivity rate of 2.19%. Thirteen additional cases were identified by 3rd generation EIA (5) and by HIV-PCR (8) accounting for 5% of all newly identified infections. Twelve (92%) provided contact information and were successfully linked to care; one patient did not provide information and was not located. All 3rd generation positives were WB- and PCR+. All acute infections were among MSM, though MSM accounted for 58% of the total testing population. Statistical analysis of other demographic and behavioral risk variables was limited by small case numbers.
Conclusions: Additional screening proved valuable for identifying acute HIV infections in this population. Anonymous testing did not appear to present significant barriers to additional screening or linkage to care. Targeting additional screening to MSM may improve cost-effectiveness without diminishing case-finding contributions.
Implications for Programs, Policy, and Research: Successful collaborations between health departments and CBOs with sufficient infrastructure and medical oversight can enhance HIV case-finding by using enhanced HIV testing algorithms. Additional research is needed to determine demographic and behavioral predictors for identifying acute HIV infection to make screening more cost-effective.