14th Annual Conference of the British HIV Association 23–25 April 2008, Belfast

DOES POINT-OF-CARE HIV TESTING IMPROVE TESTING AND DIAGNOSIS IN A HOSPITAL-BASED VOLUNTARY TESTING CLINIC?

HIV Med 2008; 9(Suppl. 1):1 (abstract no. O3)

G Nebbia¹, A Evans², Miss S Chaytor², U Nandakumar², T Fernandez², G Clewley², M Johnson¹ and AM Geretti^1
1Royal Free & University College Medical School, London, UK, ²Royal Free Hampstead NHS Trust, London, UK

BACKGROUND: Fear of venopuncture, anxiety and failure to return for results are barriers to HIV testing and diagnosis, which may be overcome by Point-of-Care (POCT) testing.

AIMS OF THE STUDY: 1) assess the performance of the Determine HIV antibody POCT on blood collected by fingerprick; 2) compare the population accessing voluntary testing by POCT with that who in the past accessed a same-day laboratory-based testing service (4hr turn-around time) in the same setting.

METHODS: The POCT was run by trained nurses and counsellors under Virology supervision and according to CPA standards. Persons with positive/equivocal Determine results and those with negative results but current/recent symptoms of possible seroconversion underwent laboratory testing.

RESULTS: 1) Of 2659 persons undergoing POCT in Feb06-Jan08, 95 tested positive; 86 were confirmed positive [Determine specificity 99.6% (99.3, 99.8); PPV 90.5% (82.8, 95.6%)]. After infection, the Determine became positive on average 6 days later than 3rd generation laboratory assays. 2) Comparing those who accessed POCT in Feb06-Jan07 with those who accessed same-day testing in Feb05-Jan06, most were male (64% versus 61%), white (67% versus 66%) or black African (13% versus 15%) and reported vaginal intercourse as the risk factor (65% versus 71%); 0.3% versus 2% did not wait for result. HIV seroprevalence was 49/1461 (3.3%) versus 65/1551 (4.2%). Most positive patients were male (55% versus 66%), white (41% versus 49%) or black African (34% versus 38%) and reported vaginal intercourse as the risk factor (61% versus 51%).

CONCLUSIONS: In a clinic-based voluntary HIV testing service, compared with same-day laboratory-based testing, HIV POCT reduces the number of those who do not wait for results. This comes at the cost of a high false positivity rate (1:11) and a significant delay in detecting early infection.

2008-04-23
O3

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