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Targeting screening and social marketing to increase detection of acute HIV infection in men who have sex with men in Vancouver, British Columbia

Gilbert, Marka,b; Cook, Darrela; Steinberg, Malcolma,d; Kwag, Michaela; Robert, Waynee; Doupe, Glenna; Krajden, Mela,b,c; Rekart, Michaela,b

doi: 10.1097/QAD.0000000000000001
Epidemiology and Social :CONCISE COMMUNICATION

Objectives: The contribution of acute HIV infection (AHI) to transmission is widely recognized, and increasing AHI diagnosis capacity can enhance HIV prevention through subsequent behavior change or intervention. We examined the impact of targeted pooled nucleic acid amplification testing (NAAT) and social marketing to increase AHI diagnosis among men who have sex with men (MSM) in Vancouver.

Design: Observational study.

Methods: We implemented pooled NAAT following negative third-generation enzyme immunoassay (EIA) testing for males above 18 years in six clinics accessed by MSM, accompanied by two social marketing campaigns developed by a community gay men's health organization. We compared test volume and diagnosis rates for pre-implementation (April 2006–March 2009) and post-implementation (April 2009–March 2012) periods. After implementation, we used linear regression to examine quarterly trends and calculated diagnostic yield.

Results: After implementation, the AHI diagnosis rate significantly increased from 1.03 to 1.84 per 1000 tests, as did quarterly HIV test volumes and acute to non-acute diagnosis ratio. Of the 217 new HIV diagnoses after implementation, 54 (24.9%) were AHIs (25 detected by pooled NAAT only) for an increased diagnostic yield of 11.5%. The average number of prior negative HIV tests (past 2 years) increased significantly for newly diagnosed MSM at the six study clinics compared to other newly diagnosed MSM in British Columbia, per quarter.

Conclusion: Targeted implementation of pooled NAAT at clinics accessed by MSM is effective in increasing AHI diagnoses compared to third-generation EIA testing. Social marketing campaigns accompanying pooled NAAT implementation may contribute to increasing AHI diagnoses and frequency of HIV testing.

aClinical Prevention Services, British Columbia Centre for Disease Control

bFaculty of Medicine, University of British Columbia

cBC Public Health Microbiology and Reference Laboratory, British Columbia Centre for Disease Control, Vancouver

dFaculty of Health Sciences, Simon Fraser University, Burnaby

eHealth Initiative for Men, Vancouver, British Columbia, Canada.

Correspondence to Dr Mark Gilbert, MD, Clinical Prevention Services, BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC V5Z 4R4, Canada. Tel: +1 604 707 5615; fax: +1 604 707 5604; e-mail:

This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivitives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.

Received February 28, 2013

Accepted July 10, 2013

© 2013 Lippincott Williams & Wilkins, Inc.