2013.02 The Use of Testing Technology to Detect HIV Infection

1.0 Purpose

This policy is to provide guidance on the use of HIV testing technologies by programs funded or otherwise supported by the DSHS HIV/STD Prevention and Care Branch.
 

2.0 Authority

Texas Health and Safety Code §§85.003; 85.032.
 

3.0 Background

Public health programs must provide access to highly sensitive and specific HIV tests to increase the capacity for communities to diagnose patients throughout the course of HIV infection. Unfortunately, strategies limited to antibody detection cannot identify highly infectious persons with acute HIV infection. In addition, multiple studies have demonstrated the inadequacy of oral fluid for rapid and confirmatory testing in identifying early infections, resulting in either negative rapid tests, or non-reactive or indeterminate Western Blot confirmatory tests. When a discordant oral fluid sample confirmatory test occurs and a blood specimen is not available, the provider and lab is unable to automatically perform a more sensitive 4th generation or Nucleic Acid Amplification Test (NAAT) that would resolve the discordant test and possibly detect acute HIV infection. These missed diagnoses represent lost opportunities for public health follow-up, to link persons with acute HIV infection into care and to reduce the risk of transmission to others.
 

4.0 Policy

HIV testing must use blood-based specimens (finger stick or venipuncture). A specimen must be collected by venipuncture on-site immediately after a point of care (e.g., rapid) preliminary positive test result and submitted to a lab for the new HIV diagnostic algorithm. All indeterminate and non-reactive confirmatory tests must be automatically referred for a NAAT to determine if a client has an acute HIV Infection. The new algorithm can be found at: cdc.gov/hiv/testing/laboratorytests.html.
 

5.0 Revision History