NJHIVCapacity Building Workshop
for Division of Addiction Services
Treatment Centers
December 8, 2009
New Jersey and AIDS
New Jersey is a high prevalence state 5th in the US in cumulative reported
AIDS cases 3 in cumulative reported pediatric AIDS
cases 1st in proportion of women with AIDS
among cumulative reported AIDS cases
Why test?
People who know they are infected with HIV are more likely to practice risk-reduction.
More people learn their HIV status, and can be referred for treatment, prevention programs, and social services.
HIV cases among IVDU
Historically, 41% of HIV cases in New Jersey are among IVDU
MSM
IVDU
MSM/ IVDU
Contactat risk
Other
New Jersey Rapid HIV Testing
Counseling sites started in mid-1980s
Testing added in late 1980s Rapid testing added in 2003 70 laboratory licenses
Health Departments, STD clinics, CBOs, Faith-based initiatives,
Hospitals,Mobile vans, Field counselors
23 Emergency Departments
2006 ASTHO Vision Award
New Jersey Rapid HIV Testing
Inventory control & /validation Training Ongoing QA
Temperature monitoring QC quality control Proficiency Testing
Regular monitoring Review of logs Site visits “Report card”
2 MD, 1 PhD, 1 manager, 6 techs
HIV detection
HIV Serotypes
HIV-1
Group MGroup O
? Group N
HIV-1
Group MGroup MGroup OGroup O
?? Group NGroup N
HIV-2
?
HIV-2
??
HIV Infection
AIDSAcute Infection Silent Infection
1-3 yearsWeeks after infection 5-10 years
Symptoms
Antibody by 3rd gen EIA
Antigen
Antibody by Western Blot
Antibody by 1st gen EIA
RNA / NAAT
HIV “Window”
Early in infection, antibody test will be negative.
Repeat testing is necessary RNA testing may shorten this
window period
A
BC
D
August 4: HIV Ab Negative
September 10: not tested
October 31:HIV EIA Positive; Western Blot indeterminate
September 30: not tested
HIV Infection
AIDSAcute Infection Silent Infection
1-3 yearsWeeks after infection 5-10 years
Symptoms
Antibody by 3rd gen EIA
Antigen
Antibody by Western Blot
Antibody by 1st gen EIA
RNA / NAAT
HIV Detection
Currently test for antibody production
Confirmatory test in state laboratory
RNA testing in pilot programs
NJ HIV testing
68,000 tests 3 years ago Over 90,000 tests this year
HIV cases among IVDU Historically, 38%
of new HIV cases were among IVDU
In the last year, only 8% of reported HIV cases were from IVDU
0
5
10
15
20
25
30
35
40
Male Total
Historic
Recent
New York City IVDU: 1990s >30% seropositivity 2000s 5-6% seropositivity Most cases are old New cases < 1% per year
New York City IVDU: HIV incidence parallels Herpes
Simplex Virus infection HIV incidence does NOT parallel
Hepatiti C Virus infection IVDU population engages in high-
risk sexual activity
Goal is for twice a year HIV testing in drug abuse population
Goal is for twice a year HIV testing in drug abuse population
SAMHSA initiatives in place to promote HIV prevention activities
Award of ~$250,000 in New Jersey from SAMHSA
Today’s Focus
Help DAS programs catch up to DHAS programs in HIV testing and prevention efforts
Help DAS programs to be in a position to apply for supplemental SAMHSA funding
Work together to increase HIV testing