Targeting screening and social marketing to increase detection of acute HIV infection in men who have sex with men in Vancouver, British Columbia.
OBJECTIVE
The contribution of acute HIV infection (AHI) to transmission is widely recognized, and increasing AHI diagnosis capacity can enhance HIV prevention through subsequent behavior change or intervention. We examined the impact of targeted pooled nucleic acid amplification testing (NAAT) and social marketing to increase AHI diagnosis among men who have sex with men (MSM) in Vancouver.


METHODS
Observational study.


METHODS
We implemented pooled NAAT following negative third-generation enzyme immunoassay (EIA) testing for males above 18 years in six clinics accessed by MSM, accompanied by two social marketing campaigns developed by a community gay men's health organization. We compared test volume and diagnosis rates for pre-implementation (April 2006-March 2009) and post-implementation (April 2009-March 2012) periods. After implementation, we used linear regression to examine quarterly trends and calculated diagnostic yield.


RESULTS
After implementation, the AHI diagnosis rate significantly increased from 1.03 to 1.84 per 1000 tests, as did quarterly HIV test volumes and acute to non-acute diagnosis ratio. Of the 217 new HIV diagnoses after implementation, 54 (24.9%) were AHIs (25 detected by pooled NAAT only) for an increased diagnostic yield of 11.5%. The average number of prior negative HIV tests (past 2 years) increased significantly for newly diagnosed MSM at the six study clinics compared to other newly diagnosed MSM in British Columbia, per quarter.


CONCLUSIONS
Targeted implementation of pooled NAAT at clinics accessed by MSM is effective in increasing AHI diagnoses compared to third-generation EIA testing. Social marketing campaigns accompanying pooled NAAT implementation may contribute to increasing AHI diagnoses and frequency of HIV testing.
aClinical Prevention Services, British Columbia Centre for Disease Control bFaculty of Medicine, University of British Columbia cBC Public Health Microbiology and Reference Laboratory, British Columbia Centre for Disease Control, Vancouver dFaculty of Health Sciences, Simon Fraser University, Burnaby eHealth Initiative for Men, Vancouver, British Columbia, Canada.
Mark
M
Gilbert
Darrel
D
Cook
Malcolm
M
Steinberg
Michael
M
Kwag
Wayne
W
Robert
Glenn
G
Doupe
Mel
M
Krajden
Michael
M
Rekart
D000328:Adult; D001955:British Columbia / Q000453:epidemiology; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D018451:Homosexuality, Male; D006801:Humans; D007124:Immunoenzyme Techniques / Q000379:methods; D008297:Male; D008403:Mass Screening / Q000379:methods*; D021141:Nucleic Acid Amplification Techniques / Q000379:methods; D040241:Social Marketing; D055815:Young Adult