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Acute Infection Screening and Prevention (AISAP)

Acute Infection Screening and Prevention (AISAP). Pat Simmons Florida Department of Health Division of Disease Control Bureau of HIV/AIDS Early Intervention Program Counseling and Testing Section. AREA 14. AREA 1. AREA 9. AREA 3. AREA 5. HARDEE. PALM BEACH. ESCAMBIA. ALACHUA. PASCO.

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Acute Infection Screening and Prevention (AISAP)

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  1. Acute Infection Screening and Prevention (AISAP) Pat Simmons Florida Department of Health Division of Disease Control Bureau of HIV/AIDS Early Intervention Program Counseling and Testing Section

  2. AREA 14 AREA 1 AREA 9 AREA 3 AREA 5 HARDEE PALM BEACH ESCAMBIA ALACHUA PASCO HIGHLANDS BRADFORD OKALOOSA PINELLAS AREA 10 POLK COLUMBIA SANTA ROSA AREA 6 BROWARD DIXIE WALTON HILLSBOROUGH AREA 15 GILCHRIST AREA 11 MANATEE INDIAN RIVER HAMILTON DADE AREA 2 MARTIN LAFAYETTE AREA 7 MONROE BAY OKEECHOBEE LEVY BREVARD CALHOUN AREA 12 ST LUCIE PUTNAM ORANGE FRANKILIN FLAGLER SUWANNEE OSCEOLA GADSDEN VOLUSIA UNION SEMINOLE GULF HOLMES AREA 13 AREA 8 JACKSON CITRUS CHARLOTTE JEFFERSON HERNANDO COLLIER AREA 4 LEON LAKE DESOTO BAKER LIBERTY MARION GLADES CLAY MADISON SUMTER HENDRY DUVAL TAYLOR LEE NASSAU WAKULLA SARASOTA ST JOHNS WASHINGTON FloridaAISAP StudyCounties HOLMES OKALOOSA ESCAMBIA JACKSON 3 SANTA ROSA NASSAU WASHINGTON JEFFERSON GADSDEN WALTON HAMILTON LEON MADISON CALHOUN DUVAL 4 BAY BAKER SUWANNEE 1 WAKULLA LIBERTY TAYLOR COLUMBIA UNION CLAY ST JOHNS GULF FRANKLIN LAFAYETTE BRADFRD GILCHRIST ALACHUA PUTNAM DIXIE 2 FLAGLER LEVY 12 MARION VOLUSIA CITRUS LAKE 13 SUMTER SEMINOLE HERNADO BREVARD ORANGE 7 PASCO OSCEOLA HILLSBOROUGH 5 POLK PINELLAS 14 INDIAN RIVER MANATEE 15 HARDEE OKEECHOBEE 6 HIGHLANDS ST LUCIE DESOTO SARASOTA MARTIN 8 GLADES CHARLOTTE 9 HENDRY LEE PALM BEACH 10 BROWARD COLLIER DADE MONROE 11 Duval, Hillsborough, Pinellas, Orange

  3. 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

  4. The Sites and DIS: Collect, spin, ship Respond before lab result is mailed Contact client as quickly as possible Initiate field records Confirmation draw TheLab: Antibody screening Pooling or individual NAAT Viral loads Report out as quickly as possible Collecting, Testing, Imparting, and Confirming

  5. 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

  6. 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

  7. 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

  8. 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

  9. RT Negative Client

  10. 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)

  11. 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

  12. First EIA / NAAT “Discordant”

  13. False NAAT Negative

  14. LessonsLearned • 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

  15. 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

  16. Bureau of Laboratories Berry Bennett Sally Fordan Olanike David Petirce Stephens Bureaus of HIV/AIDS and STD Marlene LaLota Pat Simmons Melinda Waters Dan Pope Robert Chen Dan George Stacy Shiver CDC Pragna Patel Duncan Mackellar Patrick Sullivan Steven Ethridge Michele Owen Walid Heneine Clyde Hart Angela Hutchinson Stephanie Sansom Paul Farnham It takes a village…

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