title: Acute infections, cost and time to reporting of HIV test results in three U.S. State Public Health Laboratories.
abstract: In three U.S. State Public Health Laboratories (PHLs) using a fourth-generation immunoassay (IA), an HIV-1/HIV-2 differentiation antibody IA and a nucleic acid test (NAT), we characterized the yield and time to reporting of acute infections, and cost per positive specimen.
  
  
  
  Routine HIV testing data were collected from July 1, 2012-June 30, 2013 for Massachusetts and Maryland PHLs, and from November 27, 2012-June 30, 2013 for Michigan PHL. Massachusetts and Michigan used fourth-generation and differentiation IAs with NAT conducted by a referral laboratory. In Maryland, fourth-generation IA repeatedly reactive specimens were followed by a Western blot (WB), and those with negative or indeterminate results were tested with a differentiation IA and HIV-1 NAT, and if positive by NAT, confirmed by a different HIV-1 NAT. Specimens from WB-positive persons at risk for HIV-2 were tested with a differentiation IA and, if positive, with an HIV-2 WB and/or differential HIV-1/HIV-2 proviral DNA polymerase chain reaction.
  
  
  
  Among 7914 specimens from Massachusetts PHL, 6069 from Michigan PHL, and 36,266 from Maryland PHL, 0.10%, 0.02% and 0.05% acute infections were identified, respectively. Massachusetts and Maryland PHLs each had 1 HIV-2 positive specimen. The median time from specimen receipt to laboratory reporting of results for acute infections at Massachusetts, Michigan and Maryland PHLs was 8, 11, and 7 days respectively. The laboratory cost per HIV positive specimen was $336 (Massachusetts), $263 (Michigan) and $210 (Maryland).
  
  
  
  Acute and established infections were found by PHLs using fourth-generation IA in conjunction with antibody tests and NAT. Time to reporting of acute HIV test results to clients was suboptimal, and needs to be streamlined to expedite treatment and interrupt transmission.
authors.affiliation: Division of HIV/AIDS Prevention, National Center for HIV, Hepatitis, STD & TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: snasrullah@cdc.gov.
authors.forename: Muazzam
authors.initials: M
authors.lastname: Nasrullah
authors.affiliation: Division of HIV/AIDS Prevention, National Center for HIV, Hepatitis, STD & TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Laura G
authors.initials: LG
authors.lastname: Wesolowski
authors.affiliation: Division of HIV/AIDS Prevention, National Center for HIV, Hepatitis, STD & TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Steven F
authors.initials: SF
authors.lastname: Ethridge
authors.affiliation: Massachusetts Department of Public Health, Boston, MA, USA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Cranston
authors.affiliation: Massachusetts Department of Public Health, Boston, MA, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Pentella
authors.affiliation: Maryland Department of Health and Mental Hygiene, Baltimore, MD, USA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Myers
authors.affiliation: Michigan Department of Health and Human Services, Lansing, MI, USA.
authors.forename: James T
authors.initials: JT
authors.lastname: Rudrik
authors.affiliation: Division of HIV/AIDS Prevention, National Center for HIV, Hepatitis, STD & TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Angela B
authors.initials: AB
authors.lastname: Hutchinson
authors.affiliation: Florida Bureau of Public Health Laboratories, Jacksonville, FL, USA.
authors.forename: Spencer B
authors.initials: SB
authors.lastname: Bennett
authors.affiliation: Massachusetts Department of Public Health, Boston, MA, USA.
authors.forename: Barbara G
authors.initials: BG
authors.lastname: Werner
mesh_terms: D000208:Acute Disease; D000465:Algorithms; D015153:Blotting, Western; D064790:Clinical Laboratory Services; D015483:HIV Antibodies / Q000097:blood; D015658:HIV Infections / Q000453:epidemiology* / Q000821:virology; D015497:HIV-1 / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification*; D015498:HIV-2 / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification*; D006801:Humans; D007118:Immunoassay; D008403:Mass Screening; D021141:Nucleic Acid Amplification Techniques / Q000379:methods; D012367:RNA, Viral / Q000097:blood; D012680:Sensitivity and Specificity; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D014492:United States Public Health Service / Q000706:statistics & numerical data
chemical_list: D015483:HIV Antibodies; D012367:RNA, Viral
keywords: Acute infections; Cost; Fourth-generation immunoassay; HIV testing algorithms; Time to reporting