Delaney Kevin P, Rurangirwa Jacqueline, Facente Shelley, Dowling Teri, Janson Mike, Knoble Thomas, Vu Annie, Hu Yunyin W, Kerndt Peter R, King Jan, Scheer Susan
*Division of HIV/AIDS Prevention, US Centers for Disease Control and Prevention, Atlanta, GA;†Division of HIV and STD Programs, Department of Public Health, County of Los Angeles, Los Angeles, CA;‡HIV Prevention Section, San Francisco Department of Public Health, San Francisco, CA;§HIV Epidemiology Section, San Francisco Department of Public Health, San Francisco, CA; and‖Department of Public Health, County of Los Angeles, Los Angeles, CA.
J Acquir Immune Defic Syndr. 2016 Jan 1;71(1):78-86. doi: 10.1097/QAI.0000000000000807.
Use of a rapid HIV testing algorithm (RTA) in which all tests are conducted within one client appointment could eliminate off-site confirmatory testing and reduce the number of persons not receiving confirmed results.
An RTA was implemented in 9 sites in Los Angeles and San Francisco; results of testing at these sites were compared with 23 sites conducting rapid HIV testing with off-site confirmation. RTA clients with reactive results on more than 1 rapid test were considered HIV+ and immediately referred for HIV care. The positive predictive values (PPVs) of a single rapid HIV test and the RTA were calculated compared with laboratory-based confirmatory testing. A Poisson risk regression model was used to assess the effect of RTA on the proportion of HIV+ persons linked to HIV care within 90 days of a reactive rapid test.
The PPV of the RTA was 100% compared with 86.4% for a single rapid test. The time between testing and receipt of RTA results was on average 8 days shorter than laboratory-based confirmatory testing. For risk groups other than men who had sex with men, the RTA increased the probability of being in care within 90 days compared with standard testing practice.
The RTA increased the PPV of rapid testing to 100%, giving providers, clients, and HIV counselors timely information about a client's HIV-positive serostatus. Use of RTA could reduce loss to follow-up between testing positive and confirmation and increase the proportion of HIV-infected persons receiving HIV care.
使用一种快速艾滋病毒检测算法（RTA），即所有检测都在一次客户预约内完成，可以消除异地确证检测，并减少未收到确证结果的人数。
在洛杉矶和旧金山的9个地点实施了RTA；将这些地点的检测结果与23个进行异地确证的快速艾滋病毒检测地点的结果进行比较。RTA检测结果呈反应性的客户如果多次快速检测呈反应性，则被视为艾滋病毒阳性，并立即被转介接受艾滋病毒治疗。将单次快速艾滋病毒检测和RTA的阳性预测值（PPV）与基于实验室的确证检测进行比较计算。使用泊松风险回归模型评估RTA对快速检测呈反应性后90天内与艾滋病毒治疗相关的艾滋病毒阳性者比例的影响。
RTA的PPV为100%，而单次快速检测的PPV为86.4%。从检测到收到RTA结果的时间平均比基于实验室的确证检测短8天。对于男男性行为者以外的风险群体，与标准检测做法相比，RTA增加了90天内接受治疗的可能性。
RTA将快速检测的PPV提高到了100%，为提供者、客户和艾滋病毒咨询顾问提供了有关客户艾滋病毒阳性血清状态的及时信息。使用RTA可以减少从检测呈阳性到确证之间的失访情况，并增加接受艾滋病毒治疗的艾滋病毒感染者比例。
