title: 4th generation HIV screening in Massachusetts: a partnership between laboratory and program.
abstract: BACKGROUND
  The Massachusetts Department of Public Health's (MDPH) Office of HIV/AIDS (OHA) and Hinton State Laboratory Institute (HSLI) have offered HIV screening since 1985. Point-of-care screening and serum collection for laboratory-based testing is conducted at clinic and non-clinic-based sites across Massachusetts as part of an integrated communicable disease screening intervention.
  MDPH aimed to transition to a 4th generation HIV screening-based algorithm for testing all serum specimens collected at OHA-funded programs and submitted to the HSLI to detect acute HIV infections, detect and differentiate HIV-1 and HIV-2 infections, eliminate indeterminate results, reduce cost and turnaround time, and link newly diagnosed HIV+ individuals to care. The HSLI and OHA created a joint project management team to plan and lead the transition.
  
  
  RESULTS
  The laboratory transitioned successfully to a 4th generation screening assay as part of a revised diagnostic algorithm. In the 12 months since implementation, a total of 7984 serum specimens were tested with 258 (3.2%) positive for HIV-1 and one positive for HIV-2. Eight were reported as acute HIV-1 infections. These individuals were linked to medical care and partner services in a timely manner. Turnaround time was reduced and the laboratory realized an overall cost savings of approximately 15%.
  
  
  CONCLUSIONS
  The identification of eight acute HIV infections in the first year underscores the importance of using the most sensitive screening tests available. A multi-disciplinary program and laboratory team was critical to the success of the transition, and the lessons learned may be useful for other jurisdictions.
authors.affiliation: MDPH - Office of HIV/AIDS, 250 Washington Street, 3rd Floor, Boston, MA 02108, United States. Electronic address: Tammy.Goodhue@state.ma.us.
authors.forename: Tammy
authors.initials: T
authors.lastname: Goodhue
authors.affiliation: MDPH - Hinton State Laboratory Institute, 305 South Street, Jamaica Plain, MA 02130, United States. Electronic address: Arthur.Kazianis@state.ma.us.
authors.forename: Arthur
authors.initials: A
authors.lastname: Kazianis
authors.affiliation: MDPH - Bureau of Infectious Disease, 305 South Street, Jamaica Plain, MA 02130, United States. Electronic address: Barbara.Werner@state.ma.us.
authors.forename: Barbara G
authors.initials: BG
authors.lastname: Werner
authors.affiliation: MDPH - Hinton State Laboratory Institute, 305 South Street, Jamaica Plain, MA 02130, United States. Electronic address: Tracy.Stiles@state.ma.us.
authors.forename: Tracy
authors.initials: T
authors.lastname: Stiles
authors.affiliation: MDPH - Office of HIV/AIDS, 250 Washington Street, 3rd Floor, Boston, MA 02108, United States. Electronic address: Barry.Callis@state.ma.us.
authors.forename: Barry P
authors.initials: BP
authors.lastname: Callis
authors.affiliation: MDPH - Office of HIV/AIDS, 250 Washington Street, 3rd Floor, Boston, MA 02108, United States. Electronic address: Dawn.Fukuda@state.ma.us.
authors.forename: H
authors.initials: H
authors.lastname: Dawn Fukuda
authors.affiliation: MDPH - Bureau of Infectious Disease, 305 South Street, Jamaica Plain, MA 02130, United States. Electronic address: Kevin.Cranston@state.ma.us.
authors.forename: Kevin
authors.initials: K
authors.lastname: Cranston
mesh_terms: D000465:Algorithms; D003955:Diagnostic Tests, Routine / Q000379:methods*; D015658:HIV Infections / Q000175:diagnosis* / Q000821:virology; D015497:HIV-1 / Q000145:classification / Q000235:genetics / Q000276:immunology; D015498:HIV-2 / Q000145:classification / Q000276:immunology; D006801:Humans; D007118:Immunoassay / Q000379:methods; D008404:Massachusetts; D009313:National Health Programs / Q000458:organization & administration*; D021141:Nucleic Acid Amplification Techniques / Q000379:methods; D012680:Sensitivity and Specificity; D013997:Time Factors
keywords: 4th generation HIV screening; Detecting acute HIV infection; HIV/AIDS; Laboratory and program partnership; Revised HIV testing algorithm