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: firstname.lastname@example.org
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Received February 28, 2013
Accepted July 10, 2013