Acute Infection Screening and

Prevention (AISAP)Pat Simmons

Florida Department of HealthDivision of Disease Control

Bureau of HIV/AIDSEarly Intervention Program

Counseling and Testing Section

AREA 1

ESCAMBIA

OKALOOSA

SANTA ROSA

WALTON

AREA 2

BAY

CALHOUN

FRANKILIN

GADSDEN

GULF

HOLMES

JACKSON

JEFFERSON

LEON

LIBERTY

MADISON

TAYLOR

WAKULLA

WASHINGTON

AREA 3

ALACHUA

BRADFORD

COLUMBIA

DIXIE

GILCHRIST

HAMILTON

LAFAYETTE

LEVY

PUTNAM

SUWANNEE

UNION

AREA 4

BAKER

CLAY

DUVAL

NASSAU

ST JOHNS

AREA 5

PASCO

PINELLAS

AREA 6

HILLSBOROUGH

MANATEE

AREA 7

BREVARD

ORANGE

OSCEOLA

SEMINOLE

AREA 8

CHARLOTTE

COLLIER

DESOTO

GLADES

HENDRY

LEE

SARASOTA

AREA 9

PALM BEACH

AREA 10

BROWARD

AREA 11

DADE

MONROE

AREA 12

FLAGLER

VOLUSIA

AREA 13

CITRUS

HERNANDO

LAKE

MARION

SUMTER

AREA 14

HARDEE

HIGHLANDS

POLK

AREA 15

INDIAN RIVER

MARTIN

OKEECHOBEE

ST LUCIE

Florida AISAP Study Counties ESCAMBIA

SANTA ROSA

OKALOOSA

WALTON

HOLMES

WASHINGTON

BAY

JACKSON

CALHOUN

GULF

LIBERTY

FRANKLIN

GADSDEN

LEON

WAKULLA

JEFFERSON

TAYLOR

MADISON

HAMILTON

SUWANNEE

LAFAYETTE

DIXIE

LEVY

GILCHRIST

COLUMBIA

ALACHUA

UNION

BRADFRD

NASSAU

MARION

CITRUS

HERNADO

PASCO

SUMTER

LAKE

PUTNAM

CLAY

BAKER

DUVAL

ST JOHNS

FLAGLER

VOLUSIA

SEMINOLE

ORANGEBREVARD

OSCEOLA

POLK

HILLSBOROUGH

PINELLAS

MANATEE HARDEE

DESOTO

CHARLOTTE

LEE

GLADES

HENDRY

COLLIER

MONROEDADE

BROWARD

PALM BEACH

MARTIN

ST LUCIE

OKEECHOBEE

INDIAN RIVER

HIGHLANDS

11

10

9

15

7

12

4

3

2

1

13

5

6

8

14

SARASOTA

Duval, Hillsborough, Pinellas, Orange

Florida discovered:

• Use the best plasma collection tubes• Ensure specimen integrity • Incorporate negative rapids with NAAT • Designate an AHI DIS or CTL person• If possible, target NAAT for high risk• Be aware of client ART history

The Sites and DIS:• Collect, spin, ship• Respond before lab

result is mailed • Contact client as

quickly as possible• Initiate field

records• Confirmation draw

The Lab:• Antibody screening • Pooling or individual

NAAT • Viral loads • Report out as quickly

as possible

Collecting, Testing, Imparting, and Confirming

AHI and the DIS

• Call 9-1-1 DIS• Explain test results to clients• Linkage or referral to services • Partner Services • Pull confirmatory sample • Obtain follow-up appointment

Client Results 1st VL 2nd VL

P1 EIA - NAAT + 1,381,600 916,500

P2 EIA + WB I NAAT + 6,334,400 21,856

P5 EIA + WB - NAAT + 138,126 UTL

P6 EIA - NAAT + 241,547 1,204,000

P7 EIA - NAAT+ 8,700 15,900

P8 EIA - NAAT+ 204,100 53,100

P10 EIA + WB I NAAT + 1,024,000 101,300

P11 EIA - NAAT + 9,900 3,436

P12 EIA + WB I NAAT + 47,700 92,900

P14 EIA + WB - NAAT + 3,397,400 Anonymous

P15 RT – NAAT + 111,127 Pending

Total of 14 AHI Results 11 of which were true

AHI

8 Seroconverted antibody positive 3 False positive NAAT 1 Pending redraw 1 Unable to locate 1 Anonymous – Unable to locate

False NAAT Impact • 3 false positive NAAT• 2 before lab rectified • 1 after lab rectified• 2 pregnant• 1 non-English speaker

NAAT post-test counseling:Shock, denial, lots of questions, partners

cooperative

Negative serostatus post-test counseling:Lots of questions, willing to test for other STDs

AHI Snapshots

• Client did not want to receive seroconversion results, STD Hx, has tested again

• Client has alias names and addresses, STD and drug use Hx

• Client was discovered as a part of a syphilis cluster investigation

• Client is homeless, MH issues, lack of HIV knowledge, took several DIS to locate

RT Negative Client

Test Result (10/11)

Result (10/17)

OraQuick Finger stick

Non-Reactive

EIA N/A Negative

WB N/A All bands negative

NAAT NA Positive

VL N/A 111,127

AHI Partner Services

• 29% not located (4)• 71% located (10)

• 70% were tested (7)• 43% new HIV positives (3)• 29% new HIV negatives (2)• 29% repeat negatives (2)

EIA / NAAT “Discordants”

• 1st client positive since mid 1990’s and does not claim any ART

• 11th client initial indeterminate /

NAAT negative; follow up concordant (positive) after two draws

First EIA / NAAT “Discordant”

Test Result (5/1) Result (5/24)

EIA RR RR

WB p24, p31, gp160

p24, gp160

NAAT Negative Negative

RT OraQuick PosMultispot Pos

N/A

VL N/A <75

CD4 CD8 Ratio

N/A 2.54

False NAAT Negative

Test Result (9/22)

Result (10/18)

Result (10/25)

EIA RR RR RR

WB p24 p24, p41, p120, p160

P24, p41 I, p120 I, p160

NAAT Negative Unsatisfactory

Positive

Lessons Learned

• Sites must fully understand AHI • Budgets need to sustain AHI detection • DIS staffing must be sufficient • Provide access to services for AHI • ART history may yield a NAAT negative• Reduce unsats

If Florida were to do this again, say in the Miami/Dade area…..

…what would be done differently?

Focus on Acute Infections

Assign a coordinator within Miami-Dade

Obtain a strong STD partnership

Include negative rapids and mobile units

Bureau of Laboratories Berry BennettSally Fordan

Olanike DavidPetirce Stephens

Bureaus of HIV/AIDS and STD

Marlene LaLotaPat Simmons

Melinda WatersDan Pope

Robert ChenDan GeorgeStacy Shiver

CDCPragna Patel

Duncan MackellarPatrick SullivanSteven EthridgeMichele OwenWalid Heneine

Clyde HartAngela HutchinsonStephanie Sansom

Paul Farnham

It takes a village…