New Tools, Expanded Testing Help HIV Fight

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Recent advances in technology have improved the ability of the Virginia Department of Health (VDH) to estimate the number of new HIV cases acquired each year. Tests can help identify recent HIV infections, allowing VDH's Division of Disease Prevention to track the epidemic at an earlier stage.The new tests also provide a more precise demographic breakdown of new infections, enabling health officials to better understand how the epidemic is being transmitted and where prevention measures are most urgently needed.

The new HIV surveillance system is based on an approach known as STARHS (Serological Testing Algorithm for Recent HIV Seroconversion), which uses innovative testing technology to determine at the population level which positive HIV tests represent new HIV infections (i.e., those that occurred within approximately the past five months). Before the widespread availability of this technology, HIV diagnosis data provided the best indication of recent trends in key populations. However, diagnosis data only indicate when a person is diagnosed with HIV, not when an individual was actually infected, which can occur many years before a diagnosis.

Using this new surveillance method, VDH estimates 1,190 Virginians contracted HIV in 2006. Of those new infections in Virginia, an estimated 78% occurred in men, compared to 22% in women. African Americans aged thirteen and older represented approximately 20% of Virginia’s population in 2006, but accounted for nearly 56% of estimated new HIV infections. Mirroring national data, these new data highlight the population disparities and the continuing need for proven HIV prevention efforts to reach the people most at risk for contracting HIV.

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“The ability to estimate the number of new HIV infections and further identify which populations are at greatest risk of infection is a new tool for us in Virginia. We can use these data to bolster our efforts and implement effective prevention initiatives,” said Kathryn Hafford, director of the VDH Division of Disease Prevention. “The disparities among populations continue to highlight the necessity of targeted prevention activities.”

One such effort is a grant that expands HIV testing to populations disproportionately affected by HIV. Funding from the CDC enables testing for up to an additional 40,000 persons in Virginia. More than 80% of the new HIV tests supported by this grant are expected to occur within African American populations, including a significant proportion of uninsured individuals. The project targets the Northern, Central and Eastern regions of the state, which have historically accounted for more than 90% of the reported HIV and AIDS cases among African Americans in Virginia. Testing will be conducted in hospital emergency rooms, community health centers, correctional facilities, substance abuse treatment centers, and community based organizations.

In addition to expanded testing outreach, Virginia implemented an “opt-out” HIV screening process based on recommendations by the CDC. Adopted in July of this year as a result of legislation enacted by the Virginia General Assembly, the “opt-out” screening allows health care providers to routinely test patients for HIV in all health-care settings. The Virginia statute (§32.1-37.2) requires that, prior to HIV testing, a medical care provider inform the patient that the test is planned, provide information, and advise them of their right to decline the test. A specific written consent form is not necessary; general consent for medical care is considered sufficient.

“We have to always be thinking about and looking for new ways to reach people who might otherwise slip through the cracks,” explained Hafford. “New technology that improves our data analysis, partnerships to expand testing and progressive health care statutes help extend the reach of public health efforts and impact the lives of many more Virginians.”

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