March/April 2007 Volume 18

O074
OFFERING RAPID HIV TESTING TO MARGINALIZED SEX WORKERS IN VANCOUVER
MW Tyndall, K Shannon, V Bright, D Prasad, C Lai, R Zhang, T Kerr
Vancouver, British Columbia

Background: The use of rapid HIV testing can greatly increase the opportunity for HIV diagnosis, especially among more marginalized populations. The increasing availability of effective, once-daily HIV treatment makes diagnostic testing a priority. The aim of this study was to determine the HIV testing uptake using a rapid test among women sex workers participating in a research study in Vancouver.

Methods: The Maka Project is a community-based research initiative that aims to evaluate interventions that will reduce the risk of HIV transmission. Baseline recruitment consists of an interviewer-administered survey along with a rapid HIV test using the INSTI kit. This requires a finger prick blood specimen and produces results in 60 seconds.

Results: Between January and June 2006, 198 women participated in this study. The mean age was 35.5 (median 37) years, 46% were of Aboriginal ethnicity and all were active in sex work. In the previous 6 months, 37% had been homeless, 46% had injected heroin and 32% had injected cocaine. Forty (20%) women were known to be HIV positive and the INSTI test was reactive in 39. 152 participants reported being HIV negative and 6 reported no previous testing. In this group of 158 women, 42 (26%) did not wish to receive their test results, including 3 who were reactive on the INSTI test. There were no specific characteristics with regards to age, ethnicity, drug use patterns that identified those who did not receive their results.

Conclusions: It has been observed that many people do not return for HIV test results even after pre-test counseling. This study demonstrated that the uptake of the rapid test was high among women at risk for HIV, although 26% elected not to receive their results. Rapid HIV testing is a powerful tool that can help identify those who would benefit from HIV care, counseling and treatment.

P232
HIV RAPID TESTS AS EFFECTIVE TOOLS FOR EXPANDING THE PROVISION OF HIV SCREENING IN SUB-SAHARAN AFRICA: A CASE STUDY WITH INSTI HIV-1/HIV-2* ANTIBODY TEST (BIOLYTICAL LABORATORIES)
M Massinga Loembe , C Agossa Gbenafa , M Alary , J Lajoie , M Roger , A Labb, Cotonou, Benin; Qubec, Quebec; Montral, Quebec

Introduction: Antiretroviral therapy has recently been slowly introduced at large scale in sub-Saharan Africa countries. However, on average, only 10% of seropositive individuals know their HIV status (UNAIDS). There is an emerging need for expanding HIV testing delivery. Fast provision of test results, without blood specimen transit to centralized laboratories, is one strategy that can definitely encourage screening in resource-poor settings and facilitate access to treatment.

Objective: To evaluate the performance of a minute-only rapid test, the INSTI HIV-1/HIV-2* antibody test (bioLytical Laboratories), for the screening of female sex workers enrolled in a clinical study evaluating genetic susceptibility factors to sexual infection by HIV in Benin, West Africa.

Methods: After informed consent and pre-test counseling, blood (250 l) was collected by finger-pricking. Testing was firstly done on-site with INSTI. Positive results were confirmed with SD Bioline HIV 1/2 (Standard diagnostic, result in 10 minutes). Final result was therefore available in less than 15 minutes. Remaining blood specimen was blotted on a Whatman 3 filter paper and sent to the Maisonneuve-Rosemont Hospital (Montreal, Canada). Samples were screened for HIV antibodies using Detect-HIV (Adaltis) on eluate obtained from dried blood spot. Non-reactive samples were considered HIV-seronegative. Reactive samples were tested with Genie II HIV-1/HIV-2* (Bio-Rad). Discordant samples were further tested by INNO-LIA HIV I/II Score (Innogenetics).

Results: So far, 60/64 women have accepted the study and been screened on-site for HIV:29 were positive (48.3%) and 1 was indeterminate (INSTI equivocal, SD Bioline negative). All negative and positive results obtained with INSTI were confirmed in Montreal. The indeterminate sample was Adaltis negative and INNO-LIA negative.

Conclusion: As indicated by our preliminary data, the INSTI HIV test is well accepted and adapted for rapid and accurate provision of HIV screening in resource-limited settings. This in turn allows early reference of seropositive individuals towards care services.

P280
EFFECTIVE DELIVERY OF HIV POINT OF CARE TESTING IN A MAJOR SEXUAL HEALTH CLINIC
J Greer, C Stephen, A Lin, L Mitterni
Toronto, Ontario

Objective: The Public Health Agency of Canada estimates as many as 15,000 Canadians do not know they are HIV positive, indicating a need for new testing strategies. We evaluated the impact of sustainable delivery of a Health Canada approved 60-second Point-of-Care (POC) HIV screen test (INSTI, bioLytical Laboratories, Richmond BC) on client uptake, satisfaction and testing preference at a major sexual health clinic in downtown Toronto.

Methods: Clients attending Hassle Free Clinic for Anonymous HIV testing received pre- and post-test counseling developed for both POC and laboratory-based testing. Clients were given a choice of finger-stick blood collection for POC testing or venipuncture for lab-based testing. The first 678 people choosing POC testing were asked to fill out an 8-question client satisfaction questionnaire. Trends for demand and wait times for POC testing were monitored over time.

Results: A total of 1947 male and 891 female clients were tested between 15 May and 31 December 2006, of which 1872 men (96.1%), and 760 women (85.3%) chose the POC test. Selection of the POC test for the initial 700 clients in the study period was 89% for men and 70% for women, indicating a rising preference for POC testing over time. Of the 678 completed client satisfaction questionnaires, 98% of respondents were satisfied with the POC testing experience. There was no significant difference in HIV prevalence rates in the POC testing population (1.8%) compared to 2005 lab-based testing data (1.6%). Demand and associated wait times for POC testing in Hassle Free Clinic have risen since the study began.

Conclusions: Overall, client preference and confidence in the INSTI HIV POC test delivery at Hassle Free Clinic remains very high. Observational data indicate that effective HIV POC test delivery can potentially reduce testing barriers and encourage people to find out their HIV status.

Back to top