New HIV Test Algorithms New HIV Test Algorithms and and Revised Adult HIV Case Revised Adult HIV Case Report Form Report Form (DCH #1355) (DCH #1355) HIV Surveillance HIV/STD/VH/TB Epidemiology Section Bureau of Epidemiology Michigan Department of Community Health
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New HIV Test Algorithms and Revised Adult HIV Case Report Form (DCH #1355) HIV Surveillance HIV/STD/VH/TB Epidemiology Section Bureau of Epidemiology Michigan.
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New HIV Test AlgorithmsNew HIV Test Algorithmsandand
Revised Adult HIV Case Report Revised Adult HIV Case Report Form Form (DCH #1355)(DCH #1355)
HIV SurveillanceHIV/STD/VH/TB Epidemiology Section
Bureau of EpidemiologyMichigan Department of Community Health
2013 Adult HIV Case Report Form, 2013 Adult HIV Case Report Form, DCH 1355DCH 1355
MDCH HIV-STD WebsiteMDCH HIV-STD Website
www.michigan.gov/hivstdwww.michigan.gov/hivstd
Click on “HIV/AIDS” for:– Downloadable forms and instructions–MDCH Surveillance Contact information– Statistics, reports, projects– Presentations and brochures– CD Rules and laws– Hotlines, links to other HIV websites– Prevention and care information
Reporting Cases to MDCHReporting Cases to MDCH Traditionally prefer US mail because unlawful
to open another’s mail Currently allow fax to MDCH secure fax with
caution:– Send test fax first– Program MDCH secure fax # into your fax to
avoid mis-dialing:
313-870-5257– Let your Surveillance Contact know that it
is coming–
2013 Adult HIV Case Report Form, 2013 Adult HIV Case Report Form, Sections I and IISections I and II
2013 Adult HIV Case Report Form, 2013 Adult HIV Case Report Form, Sections III, IV, VSections III, IV, V
Section VI: DemographicsSection VI: Demographics
SectionVII: SectionVII: Patient History – Risk FactorsPatient History – Risk Factors
Section VIII: Notify PartnersSection VIII: Notify Partners Section IX: Women Section IX: Women
2013 Adult HIV Case Report Form, 2013 Adult HIV Case Report Form, Section XII: Section XII:
Testing and Treatment History Testing and Treatment History
Changes:Changes:Ever had previous positive test?Ever had previous positive test?Number of negative HIV tests in Number of negative HIV tests in 24 months 24 months preceding first positivepreceding first positiveARV: If yes, and currently still using, date of most recent use ARV: If yes, and currently still using, date of most recent use
Testing/Treatment History Questionnaire Available
XIII: Comment SectionXIII: Comment Section
Note any additional information about …– Risk factors– Info helpful to Partner Services– Referrals– If client lived in other states while
Will review 2 tests:– 4th Generation Antigen/Antibody EIA–Multispot
Note:– Will use old term: “EIA, enzyme immunoassay”
but “IA, immunoassay” is more general, correct term
– Will use old terms: “screening” and “confirmatory” tests but correct terminology now is “initial” and “supplemental” tests
Section X: Documented Lab Results Section X: Documented Lab Results 44thth Generation Antigen/Antibody Test Generation Antigen/Antibody Test
New sensitive screening test run only in laboratories at present
Not available in the U.S. as a rapid test yet 4th Generation EIA detects both:– Antibody to HIV – P24 antigen, part of the HIV structure– So picks up infections earlier than
current 3rd generation EIA that detects antibody only
Section X: Documented Lab Results Section X: Documented Lab Results Type Differentiating: e.g. MultispotType Differentiating: e.g. Multispot
If Multispot negative: Need + NAAT to diagnose HIVIf Multispot negative: Need + NAAT to diagnose HIV
In the new laboratory algorithm, why replace one confirmatory antibody test (Western blot) with another (Multispot)…when either might be negative following a 4th generation antigen /antibody screen?– Western blots are complex tests that are run in
batches to cut down cost– Multispots are rapid tests that can be run
Rapid reactive: serum sent to MDCH Lansing lab where Rapid reactive: serum sent to MDCH Lansing lab where 44thth generation EIA and Multispot are performed generation EIA and Multispot are performed
Since the Multispot was negative in this case, a positive NAT Since the Multispot was negative in this case, a positive NAT was required to make a diagnosis: either qualitative NAT, or was required to make a diagnosis: either qualitative NAT, or quantitative NAT (detectable viral load).quantitative NAT (detectable viral load).
Dual Immunoassays – 2 positive EIAs from different
manufacturers make a diagnosis– Rapid or not– Collection dates may be different–Manufacturer names must be listed–May become popular at CTR sites– Do not know yet: impact on getting