1. 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 Department of Community Health

2. 2013 Adult HIV Case Report Form, DCH 1355

3. MDCH HIV-STD Website www.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

4. Reporting 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 –

5. 2013 Adult HIV Case Report Form, Sections I and II

6. 2013 Adult HIV Case Report Form, Sections III, IV, V

7. Section VI: Demographics

8. SectionVII: Patient History – Risk Factors

9. Section VIII: Notify Partners Section IX: Women

10. Section XI: Opportunistic Illnesses Stage 3 HIV Infection (AIDS): –CD4 count < 200 cells/microlitre –CD4 percent < 14%

11. 2013 Adult HIV Case Report Form, Section XII: Testing and Treatment History Changes: Ever had previous positive test? Number of negative HIV tests in 24 months preceding first positive ARV: If yes, and currently still using, date of most recent use

12. Testing/Treatment History Questionnaire Available

13. XIII: Comment Section Note any additional information about … –Risk factors –Info helpful to Partner Services –Referrals –If client lived in other states while infected –Lab testing information you don’t know where or how to record elsewhere…

14. Section X: Documented Lab Results Will review 2 tests: –4 th 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

15. Section X: Documented Lab Results 4 th 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 4 th Generation EIA detects both: –Antibody to HIV –P24 antigen, part of the HIV structure –So picks up infections earlier than current 3 rd generation EIA that detects antibody only

16. Section X: Documented Lab Results Type Differentiating: e.g. Multispot If Multispot negative: Need + NAAT to diagnose HIV

17. Section X: Documented Lab Results New Testing Algorithms New test combinations to make a diagnosis: –Now: EIA plus Western blot –New: EIA plus Multispot (from laboratories) (plus a positive NAT if Multispot negative) –New: Dual Immunoassays: 2 positive EIAs from 2 different manufacturers E.g. “Dual Rapids” (an option for testing sites)

18. Section X: Documented Lab Results New Testing Algorithms In the new laboratory algorithm, why replace one confirmatory antibody test (Western blot) with another (Multispot)…when either might be negative following a 4 th 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 immediately following a positive “screen”

19. Section X: Documented Lab Results Testing Example Rapid reactive: serum sent to MDCH Lansing lab where 4 th generation EIA and Multispot are performed

20. Section X: Documented Lab Results Multispot Negative Since the Multispot was negative in this case, a positive NAT was required to make a diagnosis: either qualitative NAT, or quantitative NAT (detectable viral load).

21. Section X: Documented Lab Results 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 patients into care

23. Section X: Documented Lab Results Dual Immunoassays (EIAs) Example of two rapid reactive tests:

24. CD4 counts/% and MD Diagnosis

25. Questions? Contact your MDCH HIV Case Surveillance Liaison: See jurisdiction site map and list of contacts under “Surveillance: Case Reporting and Projects” at www.michigan.gov/hivstdwww.michigan.gov/hivstd (click on HIV/AIDS) Or call: HIV Surveillance in Southfield 248-424-7910 HIV Surveillance in Lansing 517-335-8165