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Pottie K, Lotfi T, Kilzar L, Howeiss P, Rizk N, Akl EA, Dias S, Biggs BA, Christensen R, Rahman P, Magwood O, Tran A, Rowbotham N, Pharris A, Noori T, Pareek M, Morton R. The Effectiveness and Cost-Effectiveness of Screening for HIV in Migrants in the EU/EEA: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15081700. [PMID: 30096905 PMCID: PMC6121945 DOI: 10.3390/ijerph15081700] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 07/19/2018] [Accepted: 08/01/2018] [Indexed: 01/08/2023]
Abstract
Migrants, defined as individuals who move from their country of origin to another, account for 40% of newly-diagnosed cases of human immunodeficiency virus (HIV) in the European Union/European Economic Area (EU/EEA). Populations at high risk for HIV include migrants, from countries or living in neighbourhoods where HIV is prevalent, and those participating in high risk behaviour. These migrants are at risk of low CD4 counts at diagnosis, increased morbidity, mortality, and onward transmission. The aim of this systematic review is to evaluate the effectiveness and cost-effectiveness of HIV testing strategies in migrant populations and to estimate their effect on testing uptake, mortality, and resource requirements. Following a systematic overview, we included four systematic reviews on the effectiveness of strategies in non-migrant populations and inferred their effect on migrant populations, as well as eight individual studies on cost-effectiveness/resource requirements. We assessed the certainty of our results using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. The systematic reviews reported that HIV tests are highly accurate (rapid test >90% sensitivity, Western blot and ELISA >99% sensitivity). A meta-analysis showed that rapid testing approaches improve the access and uptake of testing (risk ratio = 2.95, 95% CI: 1.69 to 5.16), and were associated with a lower incidence of HIV in the middle-aged women subgroup among marginalised populations at a high risk of HIV exposure and HIV related stigma. Economic evidence on rapid counselling and testing identified strategic advantages with rapid tests. In conclusion, community-based rapid testing programmes may have the potential to improve uptake of HIV testing among migrant populations across a range of EU/EEA settings.
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Affiliation(s)
- Kevin Pottie
- Bruyère Research Institute, 85 Primrose Ave, Annex E, Ottawa, ON K1R 7G5, Canada.
- Departments of Family Medicine & Epidemiology and Community Medicine, University of Ottawa, Ottawa, ON K1N 6N5, Canada.
| | - Tamara Lotfi
- Faculty of Health Sciences, American University of Beirut, Beirut 1107 2020, Lebanon.
- AUB GRADE Center, Clinical Research Institute, American University of Beirut, Beirut 1107 2020, Lebanon.
| | - Lama Kilzar
- Faculty of Health Sciences, American University of Beirut, Beirut 1107 2020, Lebanon.
| | - Pamela Howeiss
- Department of Internal Medicine, American University of Beirut, Beirut 1107 2020, Lebanon.
| | - Nesrine Rizk
- Department of Internal Medicine, American University of Beirut, Beirut 1107 2020, Lebanon.
| | - Elie A Akl
- Faculty of Health Sciences, American University of Beirut, Beirut 1107 2020, Lebanon.
- AUB GRADE Center, Clinical Research Institute, American University of Beirut, Beirut 1107 2020, Lebanon.
- Department of Internal Medicine, American University of Beirut, Beirut 1107 2020, Lebanon.
| | - Sonia Dias
- National School of Public Health, Centro de Investigação em Saúde Pública & GHTM/IHMT, Universidade Nova de Lisboa, 2825-149 Caparica, Portugal.
| | - Beverly-Ann Biggs
- Department of Medicine/RMH at the Doherty Institute, The University of Melbourne Vic Australia, Parkville 3010, Australia.
| | - Robin Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, 2000 Frederiksberg, Denmark.
- Department of Rheumatology, Odense University Hospital, 5000 Odense, Denmark.
| | - Prinon Rahman
- Bruyère Research Institute, 85 Primrose Ave, Annex E, Ottawa, ON K1R 7G5, Canada.
| | - Olivia Magwood
- Bruyère Research Institute, 85 Primrose Ave, Annex E, Ottawa, ON K1R 7G5, Canada.
| | - Anh Tran
- NHMRC Clinical Trials Centre, The University of Sydney, Campbell 2006, Australia.
| | - Nick Rowbotham
- NHMRC Clinical Trials Centre, The University of Sydney, Campbell 2006, Australia.
| | - Anastasia Pharris
- European Centre for Disease Prevention and Control, 16973 Solna, Sweden.
| | - Teymur Noori
- European Centre for Disease Prevention and Control, 16973 Solna, Sweden.
| | - Manish Pareek
- Department of Infection, Immunity and Inflammation, University of Leicester, Leicester LE1 7RH, UK.
| | - Rachael Morton
- NHMRC Clinical Trials Centre, The University of Sydney, Campbell 2006, Australia.
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O'Malley EM, Scott RD, Gayle J, Dekutoski J, Foltzer M, Lundstrom TS, Welbel S, Chiarello LA, Panlilio AL. Costs of Management of Occupational Exposures to Blood and Body Fluids. Infect Control Hosp Epidemiol 2015; 28:774-82. [PMID: 17564978 DOI: 10.1086/518729] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2006] [Accepted: 12/15/2006] [Indexed: 11/04/2022]
Abstract
Objective.To determine the cost of management of occupational exposures to blood and body fluids.Design.A convenience sample of 4 healthcare facilities provided information on the cost of management of occupational exposures that varied in type, severity, and exposure source infection status. Detailed information was collected on time spent reporting, managing, and following up the exposures; salaries (including benefits) for representative staff who sustained and who managed exposures; and costs (not charges) for laboratory testing of exposure sources and exposed healthcare personnel, as well as any postexposure prophylaxis taken by the exposed personnel. Resources used were stratified by the phase of exposure management: exposure reporting, initial management, and follow-up. Data for 31 exposure scenarios were analyzed. Costs were given in 2003 US dollars.Setting.The 4 facilities providing data were a 600-bed public hospital, a 244-bed Veterans Affairs medical center, a 437-bed rural tertiary care hospital, and a 3,500-bed healthcare system.Results.The overall range of costs to manage reported exposures was $71-$4,838. Mean total costs varied greatly by the infection status of the source patient. The overall mean cost for exposures to human immunodeficiency virus (HIV)-infected source patients (n = 19, including those coinfected with hepatitis B or C virus) was $2,456 (range, $907-$4,838), whereas the overall mean cost for exposures to source patients with unknown or negative infection status (n = 8) was $376 (range, $71-$860). Lastly, the overall mean cost of management of reported exposures for source patients infected with hepatitis C virus (n = 4) was $650 (range, $186-$856).Conclusions.Management of occupational exposures to blood and body fluids is costly, the best way to avoid these costs is by prevention of exposures.
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Affiliation(s)
- Emily M O'Malley
- Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
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Montufar Andrade FE, Madrid Muñoz CA, Villa Franco JP, Diaz Correa LM, Vega Miranda J, Vélez Rivera JD, Palacio Castaño VM, Zuleta Tobón JJ, Montufar Pantoja MC, Salazar Valderrama N, Pérez Jaramillo LE, Monsalve MA, Zapata H, Mejia M. Accidentes ocupacionales de riesgo biológico en Antioquia, Colombia. Enero de 2010 a diciembre de 2011. INFECTIO 2014. [DOI: 10.1016/j.infect.2014.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Abstract
The HIV pandemic continues to expand throughout Africa and southern Asia. Despite recent advances in therapy, the primary means of prevention continues to be the identification of infected patients through diagnostic testing, and the provision of counseling services to reduce HIV transmission. In order to facilitate the identification of infected patients, great strides have been made during the past 10 years towards the development of simple, rapid HIV antibody assays that require no specialized equipment, are relatively stable at ambient temperatures and can be easily performed by people who do not have a laboratory background. Evaluations of these assays have shown that when used in multiple assay algorithm strategies, they perform comparably with current laboratory-based methods. Effective global implementation of these tests will require a concerted effort from public and private health agencies, however, expanding the use of these assays can provide a significant opportunity to slow the devastating spread of HIV.
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Affiliation(s)
- Timothy C Granade
- Division of HIV/AIDS Prevention, National Center for HIV, STD and TB Prevention, Centers for Disease Control and Prevention, Mailstop D-12, Atlanta, GA 30333, USA.
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Singh AE, Lee B, Fenton J, Preiksaitis J. The INSTI HIV-1/HIV-2 antibody test: a review. ACTA ACUST UNITED AC 2013; 7:299-308. [PMID: 23480561 DOI: 10.1517/17530059.2013.774370] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Rapid HIV tests have been widely adopted globally as an important component of HIV prevention and control programs. The INSTI™ HIV-1/HIV-2 antibody test is a second-generation HIV antibody test, available in most countries for use from whole blood, serum, and plasma. AREAS COVERED Available data on kit characteristics and current performance data on the INSTI™ HIV-1/HIV-2 antibody test are presented together with six other rapid point-of-care tests (RPOCTs) for HIV antibody. Few published data are available providing direct comparisons of INSTI™ with other RPOCTs for HIV antibody and standard laboratory-based HIV-1/HIV-2 antibody assays. Existing data showed that INSTI™ has comparable performance to other RPOCTs but detected seroconversion later than standard laboratory-based assays. EXPERT OPINION The good performance of INSTI HIV-1/HIV-2 antibody test, its ease of use, the rapid availability of results (< 5 min), and the lack of specialized equipment required to use the kit make this kit a useful addition to the global market. The unique antigen and flow through technology contained in the kit make it a strong addition to HIV RPOCTs and to rapid/rapid algorithms used in many resource-limited settings.
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Affiliation(s)
- Ameeta E Singh
- University of Alberta, Department of Medicine, Division of Infectious Diseases, c/o 3B20-11111 Jasper Ave, Edmonton, Alberta, Canada.
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Abraham AJ, O'Brien LA, Knudsen HK, Bride BE, Smith GR, Roman PM. Patient characteristics and availability of onsite non-rapid and rapid HIV testing in US substance use disorder treatment programs. J Subst Abuse Treat 2013; 44:120-5. [PMID: 22538173 PMCID: PMC3408854 DOI: 10.1016/j.jsat.2012.03.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Revised: 02/16/2012] [Accepted: 03/19/2012] [Indexed: 01/24/2023]
Abstract
Racial and ethnic minorities and injection drug users (IDUs) are at increased risk of HIV infection. However, the associations between these caseload characteristics and the availability of onsite HIV testing in substance use disorder treatment programs are unknown. This study uses data collected in 2008-2009 from 198 program administrators of treatment programs participating in the National Institute on Drug Abuse's Clinical Trials Network to address this gap in the literature. Results show positive associations between the percentages of African American, Hispanic, and IDU patients and the odds of offering non-rapid onsite HIV testing versus no onsite testing. The associations between racial/ethnic composition and the availability of rapid HIV testing were more complicated. These findings suggest that many programs are responding to the needs of at-risk populations. However, programs and their patients may benefit from greater adoption of rapid testing which is less costly and better ensures that patients receive their results.
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Affiliation(s)
- Amanda J Abraham
- Owens Institute for Behavioral Research, University of Georgia, Athens GA, USA.
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Lee BE, Plitt S, Fenton J, Preiksaitis JK, Singh AE. Rapid HIV tests in acute care settings in an area of low HIV prevalence in Canada. J Virol Methods 2010; 172:66-71. [PMID: 21192977 DOI: 10.1016/j.jviromet.2010.12.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Revised: 12/16/2010] [Accepted: 12/22/2010] [Indexed: 11/25/2022]
Abstract
Rapid HIV testing has the potential to improve medical care and reduce the transmission of infection. In this study, rapid HIV testing was performed on serum samples in acute care settings in five hospitals from urban and rural regions using the INSTI™ HIV-1/HIV-2 Rapid Antibody Test (bioLytical Laboratories, Richmond, British Columbia). Parallel standard HIV antibody tests were performed at the provincial reference laboratory. Patient demographics, indication for testing and risk behaviours were collected. From April 30, 2007 and November 23, 2009, 1708 individuals were tested: 875 (50.3%) tests in pregnant women, 730 (42%) in source individuals in blood and body fluid exposures and 119 (5.8%) in acutely ill persons. Twenty-five (1.4%) samples were reactive by rapid HIV testing, of which 13 were reactive previously and 1 was a false reactive. Sensitivity of the rapid HIV test compared to standard HIV testing was 100%, specificity was 99.9%, the positive predictive value was 96% and the negative predictive value was 100%. The median time from specimen collection to availability of the rapid HIV result varied by site and ranged from 54 min to 1h 42 min. In this study, the INSTI™ HIV-1 Rapid Antibody test identified reactive and non-reactive samples with similar accuracy to the conventional testing algorithm and provided a reliable way to perform rapid HIV testing in acute care settings.
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Affiliation(s)
- Bonita E Lee
- Provincial Laboratory for Public Health, Edmonton, Alberta, Canada
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Loubiere S, Moatti JP. Economic evaluation of point-of-care diagnostic technologies for infectious diseases. Clin Microbiol Infect 2010; 16:1070-6. [PMID: 20670289 DOI: 10.1111/j.1469-0691.2010.03280.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
We review the growing number of economic evaluations of individual point-of-care (POC) tests for diagnosis of infectious diseases in resource-limited settings that use either cohort studies or mathematical models. We focus on studies that evaluate POC diagnostic tests for the control of human immunodeficiency virus (HIV) and malaria, tools that are central to the WHO prevention guidelines for infectious diseases in developing countries. Although rapid diagnostic tests for HIV and malaria seem to be cost-effective in these standard analyses, these do not take into account the reduction in patients' waiting time and the number of clinic visits required to receive results, or future benefits from the reduction in antimalarial drug pressure. Those additional cost reductions would be considerably greater with POC rapid tests, and the cost-effectiveness of POC tests would therefore be improved. Findings from cost-effectiveness analyses suggest that, despite the relatively small additional cost incurred, decision-makers should strongly consider using POC tests throughout or during parts of HIV and malaria epidemics, where this is feasible in terms of local human resources and logistical conditions.
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Pinkerton SD, Bogart LM, Howerton D, Snyder S, Becker K, Asch SM. Cost of rapid HIV testing at 45 U.S. hospitals. AIDS Patient Care STDS 2010; 24:409-13. [PMID: 20578906 DOI: 10.1089/apc.2009.0348] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In 2006, the United States Centers for Disease Control and Prevention (CDC) recommended expanded and routine use of single-session rapid HIV tests in all health care settings to increase the proportion of persons who learn their HIV status. Limited empiric information is available regarding the costs of rapid testing and pre- and posttest counseling in health care settings. We surveyed 45 U.S. hospitals during 2005 through 2006 to assess the costs associated with rapid testing and counseling. Cost analyses were conducted from the provider (hospital) perspective, and results were expressed in year 2006 U.S. dollars. The mean per-test cost of rapid HIV testing and counseling was $48.07 for an HIV-negative test and $64.17 for a preliminary-positive test. Pre- and posttest counseling costs accounted for 38.4% of the total cost of rapid testing for HIV-negative patients. Counseling costs were significantly correlated with overall test costs. Many hospitals contained overall test costs by limiting time spent in pre- and posttest counseling or by using lower-paid personnel for counseling activities or both. Counseling costs constituted a significant proportion of the overall costs of rapid testing and counseling activities at study hospitals. Our data provide useful baseline data before implementation of the CDC's 2006 recommendations. Costs can be reduced by limiting time spent in pre- and posttest counseling or by using lower-paid personnel for counseling activities or both.
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Affiliation(s)
- Steven D. Pinkerton
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Laura M. Bogart
- RAND Corporation Health Program, Santa Monica, California
- Children's Hospital Boston/Harvard Medical School, Boston, Massachusetts
| | - Devery Howerton
- Laboratory Practice Evaluation and Genomics Branch, Division of Laboratory Systems, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan Snyder
- VA Greater Los Angeles Healthcare Network, Los Angeles, California
| | - Kirsten Becker
- RAND Corporation Health Program, Santa Monica, California
| | - Steven M. Asch
- RAND Corporation Health Program, Santa Monica, California
- VA Greater Los Angeles Healthcare Network, Los Angeles, California
- David Geffen School of Medicine at UCLA, Los Angeles, California
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Abstract
Virological, epidemiologic, and operational barriers have slowed the progress toward effective management and eradication of HIV infection, despite significant advances in diagnosis since the early 1980s. Because early diagnosis profoundly affects the health care and survival of infected/high-risk individuals, and because the time required for conventional testing remains a barrier in many settings, rapid HIV testing has been developed for use both in the clinical laboratory and at the point of care. Recent studies have identified applications, advantages, and limitations of these assays, which may influence the development of new and more effective public health testing and screening protocols. In the United States, the Food and Drug Administration has approved the use of six rapid HIV tests. This review summarizes these modern rapid point-of-care HIV tests and their role in preventing the spread of HIV and in detecting, managing, and treating patients affected by the HIV pandemic.
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Affiliation(s)
- Sheldon Campbell
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT 06520, USA.
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11
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Fritz JM, Fraser VJ, Henderson DK. Preventing occupational HIV infection in the health-care environment. Infect Dis (Lond) 2010. [DOI: 10.1016/b978-0-323-04579-7.00086-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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12
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Lazzari MA. An Example of How Rural Clinical Laboratories Can Introduce HIV Testing Cost Effectively. Lab Med 2009. [DOI: 10.1309/lmxa54m7nfdwaioq] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Franco-Paredes C, Tellez I, del Rio C. Rapid HIV testing: a review of the literature and implications for the clinician. Curr HIV/AIDS Rep 2006; 3:169-75. [PMID: 17032576 DOI: 10.1007/s11904-006-0012-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
HIV counseling and testing services are critical for individuals to access HIV prevention and treatment. Unfortunately, the standard HIV testing algorithm is complex and includes the use of a sensitive enzyme immunoassay (EIA), followed by a Western blot if the EIA is positive. This process can take 1 week or longer. Therefore, innovative approaches that incorporate simpler diagnostic algorithms are needed to reach the large number of individuals who are not aware that they are HIV-infected. Currently available rapid HIV tests have demonstrated sensitivities and specificities comparable to those of standard HIV testing without the requirements of sophisticated laboratory resources or highly trained personnel. These rapid HIV tests are increasingly being used in various clinical scenarios to decrease the number of missed opportunities for detection of HIV-infection. Their use is particularly applicable in specific clinical and nonclinical settings; public health settings; labor and delivery wards; in the management of occupational exposures; and in resource-constrained settings. The overarching goals of achieving wide implementation of rapid HIV tests are to increase the number of individuals who are aware of their serostatus, to improve entry of persons with HIV into prevention and care services, and to prevent further HIV transmission.
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Affiliation(s)
- Carlos Franco-Paredes
- Grady Memorial Hospital, Emory University School of Medicine, 69 Jesse Hill Jr. Drive S.E., Atlanta, GA 30303, USA.
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Merchant RC. Update on emerging infections: news from the Centers for Disease Control and Prevention. Updated U.S. Public Health Service guidelines for the management of occupational exposures of HIV and recommendations for postexposure prophylaxis. Ann Emerg Med 2006; 47:492-5. [PMID: 16637107 DOI: 10.1016/j.annemergmed.2006.02.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Roland C Merchant
- Department of Emergency Medicine and Community Health, Brown Medical School, Providence, RI, USA
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Greenwald JL, Burstein GR, Pincus J, Branson B. A rapid review of rapid HIV antibody tests. Curr Infect Dis Rep 2006; 8:125-31. [PMID: 16524549 DOI: 10.1007/s11908-006-0008-6] [Citation(s) in RCA: 115] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Rapid HIV antibody tests recently approved by the Food and Drug Administration can help reduce unrecognized infections by improving access to testing in both clinical and nonclinical settings and increase the proportion of those tested who learn their results. Four rapid HIV antibody tests are now available in the United States; two are approved for use at point-of-care sites outside a traditional laboratory. All four tests are interpreted visually. Sites offering rapid HIV testing must periodically run external controls (known HIV-positive and HIV-negative specimens) and provide persons who undergo rapid testing a subject information sheet. This paper reviews the operating and performance characteristics, quality assurance and laboratory requirements, and HIV counseling implications of the currently available rapid HIV tests.
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Affiliation(s)
- Jeffrey L Greenwald
- Boston Medical Center, Hospital Medicine Unit, 850 Harrison Avenue, NIF 6W, Boston, MA 02118, USA.
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Landrum ML, Wilson CH, Perri LP, Hannibal SL, O'Connell RJ. Usefulness of a rapid human immunodeficiency virus-1 antibody test for the management of occupational exposure to blood and body fluid. Infect Control Hosp Epidemiol 2006; 26:768-74. [PMID: 16209383 DOI: 10.1086/502615] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To describe the usefulness of the OraQuick Rapid HIV-1 Antibody Test (OraSure Technologies, Bethlehem, PA) in cases of occupational exposure regarding its use with source-patient sera, effects on post-exposure prophylaxis (PEP) use, potential cost savings, and effects on healthcare worker (HCW) stress reaction symptoms. DESIGN Before-and-after analysis. SETTING A 269-bed, tertiary-care medical center with adjacent clinics. PARTICIPANTS All source-patients and HCWs experiencing an occupational exposure during the study period. METHODS Use of the OraQuick test with patient sera was validated prior to its use for occupational exposures. Exposures from January 1 through July 10, 2003 (enzyme immunoassay [EIA] group) and July 11 through December 31, 2003 (OraQuick group) were retrospectively reviewed and the use and cost of PEP was compared for each group. Randomly selected HCWs from both groups completed a survey to assess their stress reaction symptoms. RESULTS After exclusion, there were 71 exposures in the EIA group and 79 in the OraQuick group. OraQuick results were 100% concordant with the reference standard of EIA and Western blot using patient sera. The mean number of doses ingested per course of PEP was significantly higher for HCWs in the EIA group (3.8; range, 0 to 6) compared with the OraQuick group (1.2; range, 0 to 3; P = .016). Cost analysis revealed a mean savings of dollar 6.62 with the OraQuick test per occupational exposure. Although the survey failed to detect an overall reduction in HCW stress reaction symptoms using OraQuick for source-patient testing, 11 HCWs in the EIA group had repetitive thoughts of the exposure compared with 5 in the OraQuick group (P = .049). CONCLUSION Because of the reduction in ingested doses of unnecessary PEP and reduced cost of occupational exposure management with their use, rapid HIV-antibody tests should be the preferred method for source-patient testing following an occupational exposure.
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Affiliation(s)
- Michael L Landrum
- Department of Infectious Diseases, Wilford Hall Medical Center, Lackland Air Force Base, San Antonio, Texas 78236, USA.
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Abstract
Recent breakthroughs in technology have produced tests for HIV antibody that are highly accurate and easy to use and can give a preliminary result in 20 minutes or less. These rapid HIV tests will be used increasingly in labor and delivery wards, emergency departments, urgent care centers, and the primary care office. They have unique applications for healthcare worker exposures, military operations, public health venues, and developing countries. In this article, Drs Keenan, Keenan, and Branson discuss the advantages and limitations of rapid HIV testing in various settings.
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Affiliation(s)
- Patrick A Keenan
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Twin Cities, Minneapolis, USA.
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Puro V, Cicalini S, De Carli G, Soldani F, Antunes F, Balslev U, Begovac J, Bernasconi E, Boaventura JL, Martí MC, Civljak R, Evans B, Francioli P, Genasi F, Larsen C, Lot F, Lunding S, Marcus U, Pereira AA, Thomas T, Schonwald S, Ippolito G. Post-exposure prophylaxis of HIV infection in healthcare workers: recommendations for the European setting. Eur J Epidemiol 2004; 19:577-84. [PMID: 15330131 DOI: 10.1023/b:ejep.0000032349.57057.8a] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The European Commission funded a project for the standardisation of the management of occupational exposures to HIV/blood-borne infections and antiretroviral post-exposure prophylaxis (PEP) in Europe. Within this project, the following recommendations and rationale were formulated by experts representative of participating countries. Based on assessment of the exposure, material, and source characteristics, PEP should be started as soon as possible with any triple combination of antiretrovirals approved for the treatment of HIV-infected patients; initiation is discouraged after 72 hours Rapid HIV testing of the source could reduce inappropriate PEP. HIV testing should be performed at baseline, 4, 12, and 24 weeks, with additional clinical and laboratory monitoring of adverse reactions and potential toxicity at week 1 and 2. HIV resistance tests in the source and direct virus assays in the exposed HCW are not recommended routinely. These easy-to-use recommendations seek to maximise PEP effect while minimising its toxicity and inappropriate use.
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Affiliation(s)
- Vincenzo Puro
- Istituto Nazionale per le Malattie Infettive Lazzaro Spallanzani, IRCCS, Rome, Italy.
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Puro V, Francisci D, Sighinolfi L, Civljak R, Belfiori B, Deparis P, Roda R, Modestino R, Ghinelli F, Ippolito G. Benefits of a rapid HIV test for evaluation of the source patient after occupational exposure of healthcare workers. J Hosp Infect 2004; 57:179-82. [PMID: 15183251 DOI: 10.1016/j.jhin.2004.03.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2003] [Accepted: 03/01/2004] [Indexed: 10/26/2022]
Abstract
Rapid human immunodeficiency virus (HIV) testing for the management of occupational exposure of healthcare workers significantly decreased the number of anti-retroviral post-exposure prophylaxis regimens started whilst awaiting HIV test results. The study confirmed an equivalent performance of the rapid test in comparison with HIV enzyme immunoassay, and suggests it is cost-effective. In addition, two other potential benefits emerged: reducing the number of source patients who remain untested and increasing the number of occupational exposures reported.
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Affiliation(s)
- V Puro
- Dipartimento di Epidemiologia, Istituto Nazionale per le Malattie Infettive, Lazzaro Spallanzani, IRCCS, Via Portuense 292, 00149 Rome, Italy.
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Abstract
BACKGROUND In the United States, more than 2 million human immunodeficiency virus (HIV) antibody tests are performed annually at publicly funded HIV counseling and testing (CT) clinics. Clients do not receive results from one third of these tests because of low return rates. New rapid-testing technologies may improve receipt of results, but no study has systematically analyzed the costs of these newer technologies compared with the standard protocol. OBJECTIVE To estimate and compare the economic costs associated with three HIV CT protocols: the standard protocol and the one-step and two-step rapid protocols. METHODS A cost analysis model was developed in 2002 to calculate the intervention costs for HIV CT services with the standard CT protocol and the one-step and two-step rapid-test protocols for a hypothetical client in a publicly funded HIV clinic. Sensitivity analyses were performed to ascertain the effects of uncertainty in the model parameters. RESULTS The one-step rapid protocol was generally the least expensive of the three protocols. The standard protocol cost less than the two-step protocol per HIV-positive client notified of his or her HIV status, but cost more per HIV-negative client. The sensitivity analysis indicated overlap in the cost estimates for HIV-negative clients, reflecting the generally similar costs of the three testing protocols. Taking into account HIV seroprevalence, the two-step rapid protocol would be less expensive than the standard protocol for most publicly funded testing programs in the United States. CONCLUSIONS Rapid test protocols offer economic advantages as well as convenience, compared to the standard testing protocol. The cost estimates presented here should prove helpful to HIV program managers and other public health decision makers who need information on these counseling and testing technologies.
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Affiliation(s)
- Donatus U Ekwueme
- Division of HIV/AIDS Prevention-Intervention Research and Support, Centers for Disease Control and Prevention, 4700 Buford Highway N.E., Atlanta, GA 30341, USA.
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Ribeiro-Rodrigues R, Ferreira da Silva Pinto Neto L, Cunha CB, Cabral VP, Dietze R. Performance characteristics of a rapid new immunochromatographic test for detection of antibodies to human immunodeficiency virus. CLINICAL AND DIAGNOSTIC LABORATORY IMMUNOLOGY 2003; 10:303-7. [PMID: 12626458 PMCID: PMC150540 DOI: 10.1128/cdli.10.2.303-307.2003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A new immunochromatographic rapid test (Rapid Check HIV 1 and 2; Núcleo de Doenças Infecciosas) for the detection of antibodies to human immunodeficiency virus type 1 and type 2 in human samples (whole blood, serum, and plasma) was evaluated and compared to the commercially available Determine (Abbott Laboratories). When whole-blood samples were evaluated, the specificity and sensitivity of both tests were 100%. However, when plasma samples were used, sensitivity for the Rapid Check HIV 1&2 and the Determine tests were 100 and 98.58%, respectively. The observed specificity for plasma samples was 98.94% for the Rapid Check HIV 1&2 and 96.97% for the Determine test. The results presented here are encouraging and support the adoption of both tests as an alternative to enzyme-lined immunosorbent assay and/or Western blots in regions where laboratorial infrastructure is not available or for use in the management of occupational accidents for healthcare workers.
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Affiliation(s)
- Rodrigo Ribeiro-Rodrigues
- Cellular and Molecular Immunology Laboratory, Núcleo de Doenças Infecciosas, Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil.
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26
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Branson BM. Point-of-Care Rapid Tests for HIV Antibodies/Patientennahe Schnelltests für den Nachweis von HIV-Antikörpern. ACTA ACUST UNITED AC 2003. [DOI: 10.1515/labmed.2003.041] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Cleveland JL, Barker L, Gooch BF, Beltrami EM, Cardo D. Use of HIV postexposure prophylaxis by dental health care personnel: an overview and updated recommendations. J Am Dent Assoc 2002; 133:1619-26. [PMID: 12512659 DOI: 10.14219/jada.archive.2002.0109] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The authors conducted a study on the use of postexposure prophylaxis, or PEP, for exposure to human immunodeficiency virus, or HIV, among dental health care personnel, or DHCP, enrolled in a surveillance system established by the Centers for Disease Control and Prevention, or CDC. They also discuss updated U.S. Public Health Service, or USPHS, recommendations for managing occupational exposures to HIV, as well as considerations for dentistry. METHODS The authors analyzed occupational exposures reported by DHCP to the CDC to describe characteristics of the exposure (for example, type and severity), the source patient's HIV status and use of PEP. RESULTS From June 1995 through August 2001, DHCP reported 208 exposures--199 percutaneous injuries, six mucous membrane exposures and three skin exposures--to the CDC. One-third of these percutaneous injuries were caused by small-bore hollow syringe needles, and most (66 percent) were moderate in depth. Nearly half the devices involved (46 percent) were visibly bloody at the time of injury. Per the criteria described in USPHS guidelines, one-half of the injuries were categorized as "less severe." Twenty-four (13 percent) known source patients were HIV-positive; 14 had symptomatic HIV infection or a high viral load. In this study, three in four DHCP exposed to an HIV-positive source warranted a three-drug PEP regimen. Twenty-nine (24 percent) DHCP exposed to a source patient who subsequently was found to be HIV-negative took PEP; six took PEP for five to 29 days. No exposures resulted in HIV infection. CONCLUSIONS Findings of this study are consistent with earlier reports indicating that the risk of HIV transmission in dental settings is low. Strategies such as rapid HIV testing of source patients and follow-up counseling may reduce unnecessary use of PEP. CLINICAL IMPLICATIONS Dental practices should develop comprehensive, written programs for preventing and managing occupational exposures to blood.
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Affiliation(s)
- Jennifer L Cleveland
- Division of Oral Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, GA 30341, USA.
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Salgado CD, Flanagan HL, Haverstick DM, Farr BM. Low rate of false-positive results with use of a rapid HIV test. Infect Control Hosp Epidemiol 2002; 23:335-7. [PMID: 12083238 DOI: 10.1086/502061] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Occupational exposure to human immunodeficiency virus (HIV) is an important threat to healthcare workers. Centers for Disease Control and Prevention guidelines recommend prompt institution of prophylaxis. This requires (1) immediate prophylaxis after exposure, pending test results that may take more than 24 hours in many hospitals; or (2) performance of a rapid test. The Single Use Diagnostic System (SUDS) HIV-1 Test is used to screen rapidly for antibodies to HIV type 1 in plasma or serum, with a reported sensitivity of more than 99.9%. We used this test from January 1999 until September 2000, when it was withdrawn from the market following reports claiming a high rate of false-positive results. METHODS We reviewed the results of postexposure HIV testing during 21 months. RESULTS A total of 884 SUDS tests were performed on source patients after occupational exposures (883 negative results, 1 reactive result). The results of repeat SUDS testing on the reactive specimen were also reactive, but the results of enzyme immunoassay and Western blot testing were negative. A new specimen from the same patient showed a negative result on SUDS testing. This suggested a specificity of 99.9%. In the 4 months after SUDS testing was suspended, there was 1 false-positive result on enzyme immunoassay for 1 of 132 source patients (presumed specificity, 99.2%). CONCLUSION Use of the SUDS test facilitated rapid and accurate evaluation of source specimens, obviating unnecessary prophylaxis.
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Affiliation(s)
- Cassandra D Salgado
- Department of Medicine, University of Virginia Health System, Charlottesville 22908, USA
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