Robert Wood Johnson Medical School
April 28, 2014
Joanne Corbo, MBA – HIV
Program Manager
Website for NJ HIV Rapid Testing Support:
njhiv.org
One Time Events





Requests should be sent 10 business days in advance (No exceptions)
Must use current form (electronic version on NJ HIV.org)
Send to Sonya Thompson/copy to Joanne Corbo
Approvals done by Sonya/PMO based on strict criteria for target
population/prevalence (Criteria: zip code etc.)
Results for One Day Events must be sent to Sonya Thompson/copy to
Joanne Corbo within three business days of the event (electronic
version on NJ HIV.org)
One-Day Event Results Report
Submit one form per event within three business
days of event
Date of Event:
Sponsoring Agency:
Testing Agency (if different than sponsoring agency):
Zipcode of Testing location:
Target
#
#
Population
Positive
Negative
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
TOTAL
* General Population is any non
targeted group
Please complete the entire form. Totals will automatically add for you. "SAVE AS" naming the file with your
agency name and date of event.
Email to Joanne Corbo at corbojo@RWJMC.rutgers.edu and Sonya Thompson at sonya.thompson@doh.state.nj.us
within three business days.
Test logs:



RWJ test logs due the 10th of the month
May also be sent as they are completed
Please make sure logs are complete
 Site Number, Contact Information, shipment number
 Test information complete: Pos, Neg, Temperature, Start Time End Time, Operator Initials
 If doing second test for another site indicate second test and site number of first site

Fax to 732-235-9012 or 732-743-3632
NJHIV Positive Tracking Form



Use new form included in packet (available on NJ HIV.org)
Must be sent in as completed to RWJ
Fax to 732-235-9012 or 732-743-3632
Discordant work up/ procedure:
If second rapid or confirmatory does not match first rapid the
result is discordant
 Draw blood for work up:

 Two white top tubes (must be spun down and frozen upside down)
 One serum separator (must be spun down and refrigerated)


You must report all discordant results to RWJ
Call 732-236-7013. Leave a message with contact information
so RWJ pick up samples and process.
RWJ License renewals:
License renewals sent with a checklist
 Coordinator must sign checklist to indicate all items
necessary for regulatory compliance are in place at the
site
 Send copy of standing order indicating it has reviewed
and is current must be included
 Copy of standing order template included in packet
(available on NJ HIV.org)

Checklist for License Renewal:
Site Name___________________________
 We have the current signed RWJ NJ Rapid HIV Testing Support Program Policy Manual available at our testing location.
 We are using the current signed Exposure Control Plan provided in the RWJ NJ Rapid HIV Testing Support Program Policy
Manual.
 We have a current signed Exposure Control Plan available at our testing location if we are not using the plan provided in the
RWJ NJ Rapid HIV Testing Support Program Policy Manual.
 We have a copy of the standing order for performing Rapid HIV Testing signed by our current Medical Director or Authorized
Physician at our testing location. The standing order has to be reviewed this year; We have documented that it is current and
that the medical director (who signed it) has not changed.
 We have attached a copy of the standing order with our license application for RWJMS records.
Signed by:
________________________________________________________
Site Testing Coordinator
Standing Order Template
To Whom It May Concern:
This standing order shall constitute a request for rapid HIV testing for screenings performed at:
Name of Testing Site:
Address of Testing Site:
In cases where a client receives a preliminary positive result using a rapid HIV test, this authorizes:
HIV Western Blot and/or a second Rapid HIV test (for all preliminary positives);
and follow-up testing as appropriate to the clinical setting—which may include:
Additional HIV serology
HIV nucleic acid testing
Signature
___________________________________
Print Name____________________________________
Medical Director
Revised Frequently called Number List
Updated RWJ Rapid HIV Support Contact List
NJ HV –> Grant from Division of HIV STD & TB Services
Linda Berezny, RN – PMO
Dept. of Pathology & Lab Medicine – Robert Wood Johnson Medical
School
•
◦
◦
◦

Evan Cadoff, MD – Professor & Chairman
Eugene Martin, Ph.D. – Professor
Gratian Salaru, MD – Asst. Professor
Joanne Corbo, MBA, MT – Program Manager
◦ TECHNICAL







Latasha Adams, MT
Moeen Ahmed, MT
Claudia Carron, RN
Aida Gilanchi, MT
Franchesca Jackson, BS
Jaclyn Kollinger, MT
Nisha Patel, MT
◦ ADMINISTRATIVE


Lisa May
Karen Williams
RWJ Sites:

African American Office of Gay
Concerns
Atlantic City Health Department
AtlantiCare Mission Health (Atlantic City
Corrections)
Bergen County Health Department
Buddies of NJ
Burlington County Health Department
Camden AHEC
Camden County Health Departments
Catholic Charities (Union County Jail
and Hudson County Jail)
Checkmate, Inc
City of Trenton
City of Vineland

Complete Health Care, Inc.















Cumberland County Health Department
Dooley House
East Orange Health Department
Eric B. Chandler Health Center
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
FamCare
•
Hamilton Township STD Clinic •
Henry J. Austin Health Center •
Hispanic Family Center
•
HiTops Inc
•
Horizon Health
Hunterdon Health Department •
•
Hyacinth Foundation
Iris House
•
John Brooks Recovery
•
JSAS
•
Kean University
•
Kennedy Health
La Casa Don Pedro
•
Liberation in Truth
•
Middlesex County Public Health
Department
•
NAP Newark
NAP Trenton
•
Neighborhood Health
Newark Community Health
•
Center
•
•
Newark STD Clinic
New Horizon Health Center
NJCRI
NJ React
North Hudson Community
Action Corporation(9 sites)
Oasis Drop In Center
Ocean County Health
Department
Ocean Health Initiatives
Paterson Department of Health
Proceed
Robert Wood Johnson Medical
School
Saint James Social Services
Salem County Health
Department
South Jersey AIDS Alliance
(OASIS)
Visiting Nurse Association of
Asbury Park
Well of Hope
William Paterson University
Woodbridge Department of
Health
Non-RWJ Sites:



















Asbury Park Community Health Center/Visiting
Nurse Association
Atlantic County Health Department
Atlanti-Care Regional Medical Center
Cape May County Health Department
Cooper Medical Center-ER
Cooper Medical Center-EIP/Camden County Jail
Gloucester County Health department
Greater Northern Jersey Planned Parenthood (10
Sites)
Hoboken Family Planning- 3 sites
Hurtado Health Center (Rutgers)
Jersey City Medical Center
JFK Medical Center
Monmouth Regional Medical Center
Morristown Memorial Hospital
Newark Beth Israel
Ocean County Family Planning
Our Lady of Lourdes
Planned Parenthood Metro
Planned Parenthood of Central NJ
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Planned parenthood of Hamilton
Planned Parenthood of East Orange
Planned Parenthood of Mercer County
Planned Parenthood of Southern NJ
Raritan Bay Medical Center
Saint John’s Clinic
Saint Joseph’s Medical Center
Saint Michaels Medical Center
South Jersey Family Medicine ( 7 sites)
Trinitas Hospital
UMDNJ University Hospital ER & STOP
University of Princeton Health Center
(McCosh Infirmary)
Women’s Health & Counseling Center Somerville
Zufall Health
LEGEND
Symbol
Rapid Testing PROGRAM
COMMUNITY BASED ORG. (CBO)
MEDICAL CTR. ER
MOBILE VAN
JAILS
NJ HIV – May, 2009
Evan Cadoff, MD ...Gene Martin, PhD … Gratian Salaru, MD
• Background
 Failure to return (2005)

Missed Opportunities – AHI in NJ
 NAAT data (2012)
• Category C Outcomes
 Expansion of RTA sites in NJ
 Training in RTA
 4th Generation Lab-based Testing
 Transition to 4th Generation POC Testing
• Current limitations on 4th Gen POC Testing
• Master plan (2014-2015)
• Build out of 4th Gen. POC
• Collaboration to facilitate linkage (Orthogonal confirmation of 4th Gen.
Lab-based Positives)
• Validation of iSTOC – is there a way to objectively read rapid tests

Traditional:

Rapid Testing Options:
◦ EIA or IF confirmed by traditional methods: HIV Western
blot, IFA or Aptima
1. Rapid HIV Screen confirmed by traditional methods
(Western blot, IFA)
2. Rapid HIV Screen confirmed by an orthogonal rapid tests


“Rapid-Rapid” Model

Clearview StatPak confirmed by Trinity Unigold
1.
2.
Clearview StatPak is performed at Site #1
Transportation of Client to Site #2 (Typically a medical care
entity)
Patient Navigator at Site #2 performs second orthogonal rapid
If HIV POS  Laboratory Intake
“Rapid-2-Rapid” Model
3.
4.
3. Rapid Screen Alone – Rare in NJ
IDSA – SAN
FRANCISCO --- 2005
RWJ Sites: 97 Non RWJ Sites: 64
RWJ sites:
Rapid HIV Testing NJ
Non RWJ site:
60 Primary
24 satellites
13 mobile
64 sites including 12 ERS
Testing volume
Rapid-Rapid format:
2013 Tested
48,708
450
PRELIM POS
439
UG PERFORMED
426
UG CONFIRMED
From Inception
175,630
PRELIMINARY POS
1,503
“PRESUMPTIVE
POSITIVES”
1,407




When compared against current rapid HIV tests, NAAT tells us
we’re missing between 6-8% of those infected when we screen
for antibodies using one of the traditional rapid HIV tests
Those with the highest risk of infecting others are the ones
that are being missed!!
The same issues with patient return and process completion
occur with NAAT that occur with traditional testing!!!
Solution: A test that picks up p24 Ag COULD identify a
substantial proportion of the same population. A POCT device
could increase the pickup without losing the ability to link
patients to care.
E.G. Martin et al. / Journal of Clinical Virology 58S (2013) e24–e28
28
Program
Maryland
North
Carolina
Los
Angeles
NEWARK,
NJ
Seattle
King
County
Dates
Description
HIV Ab neg adults seen at
two STD clinics (6/06-6/06-3/08
3/08); multiple venues
7/07-3/08)
HIV Ab neg persons in
North Carolina seeking
11/02HIV testing at 110
10/03
publicly funded sites (n =
109,250)
HIV Ab neg men seeking
2/04-4/04 HIV testing at three STD
clinics (n = 1712)
HIV Ab neg adults
receiving testing and
2/10 to
counseling at two high
1/12
risk urban hospitals in
Newark, NJ
HIV Ab neg MSM seeking
HIV testing through
9/03-1/05
Seattle-King County (n =
3525)
Rapid
Tested
NAAT
Tested
58,925
HIV
Ab+
AHI
7 1,709
% HIV Ab +
% Inc in Yield % Yield AHI
2.90%
0.41%
0.01%
108,66
7
23
583
0.54%
3.95%
0.02%
1,698
1
14
0.82%
7.14%
0.06%
12,390 6,785
8
116
0.94%
6.90%
0.12%
3,439
5
81
2.36%
6.17%
0.15%
Atlanta
10/021/04
2202 adults receiving HIV
testing and counseling at
three high risk urban
sites in Atlanta, Georgia
2,136
4
66
3.09%
6.06%
0.19%
San
Francisco
10/037/04
HIV Ab neg persons
seeking HIV testing at
San Francisco Municipal
STD clinic (n = 3075)
2,722
11
105
3.86%
10.48%
0.40%
29
Receipt of Pooled RNA Results
50
40
48
30
20
10
0
19
7
Never Receive
AHI Received
Too Late for
Results
Results
Optimal
42%
Intervention
Patel et al, CDC , Archives Int Med 2010
30
Acute
HIV
Infection
31

Because individuals with AHI are highly
infectious, have engaged in high risk
behaviors, and are often unaware of their
status they contribute substantially to the
spread of HIV.

Although the duration of AHI is short (typically
3-4 weeks), studies have consistently shown
that ~ 50% of new HIV transmissions are caused
by onward transmission within the first six
months from an individual with AHI.

40-90% develop symptoms of Acute HIV

50%-90% who have symptoms seek
medical care

Of those diagnosed with Acute HIV, 50% of
patients seen at least 3 times before they are
diagnosed

LINKAGE AND TREATMENT OPPORTUNITY!

SYMPTOMS - ACUTE HIV INFECTION
◦ Rash &/or fever(s), possibly in
combination with:
◦
◦
◦
◦
◦
◦
◦
◦
◦
◦
◦
◦
◦
◦
Malaise
Loss of Appetite
Weight loss
Sore Throat
Mouth Sores
Joint Pain
Muscle Pain
Swollen lymph nodes
Diarrhea
Fatigue
Night sweats
Nausea/vomiting
Headache
Genital Sores
5
(1/30-1/200)
HIV RNA in
Semen
(Log10
copies/ml)
Risk of Transmission Male to Female - Blue
Reflects Genital Viral Burden – Yellow
Effect of ART – Theoretical - Red
4
(1/1001/1000)
3
(1/1000 –
1/10,000)
(1/500 1/2000)
2
Acute
Infection
Asymptomatic
Infection
HIV Progression
Cohen and Pilcher, JID 191:1391, 2005
AIDS
Point of Care - Based
Laboratory - Based
34
35





Substantially more sensitive than 3rd Gen. HIV assays,
earlier generation rapid HIV tests, and confirmatory
assays
Somewhat more sensitive than POC-based 4th Gen.
rapid HIV assay (Alere Determine Combo assay)
They identify a significant proportion of acutely
infected individuals (~90%)
May be used in the diagnosis of HIV-1/HIV-2
infection in pediatric subjects (i.e., children as young
as 2) and in pregnant woman
Permit the identification of established HIV infections
without the need to send-out for additional testing
36





Less sensitive than NAAT tests – (individual or pooled);
therefore MISSING some cases of AHI.
Although the manufacturer claims it is ~ 35 minutes to an
initial result, the reality is that in many laboratories the
average time to an initial single result is much longer.
Unfortunately, both FDA-approved lab-based assays
report a single combined specimen result, so neither can
differentiate initially between recent and established HIV
infections.
When used in conjunction with the new confirmatory
algorithm they provide identification of individuals who
have HIV antibodies, but require an additional NAAT test
to ‘rule in’ AHI.
As of today, the only available 4th gen. test that can on a
preliminary basis identify recent infection is the
standalone rapid test: The Determine Combo.
37
Architect package Insert:
Fully-automated,
random-access (no
Control brackets)
Stat capability
HIV Combo assay:
29 minute time to first
result
>150 tests per hour on
i2000SR
>50 tests per hour on
i1000SR
Manutac et al. JCV. 58S (2013) e44-47
38
Avg.: 57.7 min
4th Generation HIV1/2 EIA
If repeatedly reactive
Is it reproducible?
HIV-1/2 Differentiation Assay – BIORAD MULTI-SPOT
HIV +
HIV-1 -/ HIV-2 - ANTIBODIES NEGATIVE or IND
HIV-1 +/ HIV-2 –
Logistic delays?
HIV-1 antibodies detected
RNA Testing
HIV-1 -/ HIV-2 +
HIV-2 antibodies detected
HIV-1 +/ HIV-2 +
HIV antibodies detected
Additonal Testing
Required to rule out a
dual infecton
RNA +
Acute HIV Infection
RNA - NEGATIVE
40


Tests for the simultaneous and
separate qualitative detection of
free HIV-1 p24 antigen and
antibodies to HIV-1 and HIV-2.
It is intended for use as a pointof-care test to aid in the diagnosis
Lot number
Name of Test
Control Line
of infection with HIV-1 and HIV-2,
including an acute HIV-1 infection,
and may distinguish acute HIV-1
infection from established HIV-1
infection when the specimen is
positive for HIV-1 p24 antigen and
negative for anti-HIV-1 and antiHIV-2 antibodies.
Highlights
Patient
Identification
p24 Antigen Result
HIV Antibodies Result
Sample Pad
Alere Determine Ag/Ab Combo
Alere Determine™ HIV-1/2 Ag/Ab Combo Package Insert 027332530 Rev: 04 2013/09
41
Seroconversion panels
Determine HIV-1/2 (3rd gen)
Ab
Day: 0
5
7
12
14
19
21
Determine Combo (4th gen)
Ag
Ab
Day: 0
5
7
Earlier
detection
12
14
19
21
Panel AS PRB943 (BBI, Seracare)
Seroconversion panels
Determine HIV-1/2
Ab Nonreactive. Dismissed.
Ab
Determine Combo
Ag Reactive. Presumably
Recent infection.
Ag
Ab
Day: 12
Panel AS PRB943 (BBI, Seracare)
Seroconversion panels: FDA approved assays
4th Generation
Lab Assays
18.5-20 Days
Before Western
Blot positive
* Modified from Silvina M, et al. Performance of the Alere DetermineTM HIV ½ Ag/Ab Combo Rapid Test with specimens from HIV-1 serocoverters from the US and HIV-2 Infected individuals from
Ivory Coast. J Clin Virol 2013: Published Online 05 August 2013. DOI:10.1016/j.jcv.2013.07.002
44



Order of sensitivity to acute HIV infection:
◦ Individual NAAT – Aptima > Pooled NAAT >4th
Gen. Tests
 Lab-based 4th Gen: Architect/Biorad >POCT–
based 4th Gen: Determine Combo
More than half of HIV transmission is thought to
occur during the earliest phase of infection
Weighing the potential benefit of slightly improved
sensitivity versus the immediacy of the result is a
decision that needs to be driven by a careful
assessment of the circumstances involved in
particular screening programs!
45
Rapid-Rapid Monthly Test Volume 2013
6000
5000
4000
3000
2000
1000
0
TotalTest
48,708
2.2%
5.3%
62.9%
2.3%
2013 Rapid-Rapid Test Volume
Percent Refuse Unigold Verification
Percent of Prelim Positive Results not Verified by
Unigold
Percent UG Verified Connected to Care on Same
Day
Percent UG Failed to Verify of UG Performed
•
•
•
GOAL: Simplify the process. Maximize
linkage and re-engagement.
More clients complete testing and are
linked to care on the same day using an
RTA.
Average time to lab intake for HIV+
positives is < 2 business days
2013
New Pos
175,630
RTA Testing Volume SINCE INCEPTION
5.7% Percent Refuse Western blot
2.5% Percent Refuse Unigold Verification
Percent of Prelim Positive Results not Verified
3.9% by Unigold
Client
Refused
Re-Engaged Already in Care
Denied Charity
Care
No Show
Bus Days to
Lab Intake
344 POS from
Apr - Dec
SUBTOTAL
188
89
11
21
4
31
1.8
2013 RTA POS Distribution
1%
3%
9%
New Pos
6%
Re-Engaged
Already in Care
55%
26%
Client Refused
Denied Charity Care
No Show

NJ Hospitals have been slow to adopt 4 th Gen. HIV

Category C project encouraged the transition by supporting ED
testing in 2013:
◦ St. Joseph’s Medical Center (89% complete)
 Contract: 2000 tests
 To Date: 1782 tests, 7 Positives
 0 AHI, 7 Established Infections, Several FP Architects
◦ Our Lady of Lourdes (80% complete)
 Renewed Contract: 3600 tests
 To Date: 2881 tests, 18 Positives
 3 AHI, 9 Established Infections, 3 FP Architect, 3 FP StatPak
◦ Jersey Shore Univ. Medical Center (30%)
 Contract: 2400
 To Date: 70 tests, 2 Positive
 0 AHI

Increase RTA availability in NJ:
- Added 11 facilities including 8 hospitals and 1 multi-facility FQHC
- Currently RTA testing exceeds 48,000 tests per year at rapidrapid facilities
- Expand the program to include additional ‘Rapid-2-Rapid’
screening ONLY sites
- Reduces QC costs at sites with relatively few positives


Recruit Mod. Complex. Facilities to implement 4th gen. POC testing
◦ 3 hospitals have agreed
◦ 2 additional facilities have agreed
◦ 1 site begun – RWJMS
Question: How to integrate 4th gen. POC and lab-based?
◦ Consider using Determine Combo as an orthogonal confirmation
expediting identification of AHI at hospitals
APPROACH
OVERALL GOAL
1.
Expand RTA by an
additional 9 sites,
currently performing
Traditional HIV testing
estimated to test
29,000/year
Approach Non-RWJ
laboratory directors utilizing
existing HIV site
coordinators to gain entry
and begin
educational process with
Bioanalytical Lab Directors
2.
Encourage laboratory
representation at various
state planning meetings
related to Linkage to Care
and RTA testing.
3.
Publish and Present
information about RTA
guidelines and “Presumptive
Positives”
OUTCOMES
1. Eleven sites added:
•
•
•
•
•
•
•
•
•
•
•
Monmouth Regional Med Ctr./Jersey
Shore Medical Center
Trinitas Hospital
Camden County Jail
Raritan Bay Medical Center
Jersey City Medical Center
St. Joseph's
Our Lady of Lourdes
City of Trenton
UMDNJ/UH ER
Newark Beth Israel
North Hudson Community
Action (Multi-site FQHC)
2.
2013 Rapid-Rapid Testing 48,000
•
Navigator - 67 (R2R) conducted;
96% positive (4% discordant)
and all +s (100%) enrolled in
care
3.
Ms. Corbo has joined the NJ HIV Planning
Group, joined numerous collaborative
meetings
4,
Since 2005:
• Abstracts: – 44
• 29 posters
• 15 platform presentations
• 2013-4
• 2 papers
• 3 platform presentations
APPROACH
OUTCOMES
1. Validate assay using available
Performance Panels
2. Develop procedures, forms,
training program
3. Identify method for Proficiency
Testing
4. Set-up ‘Pilot Site’
1. Assay performance validated
2. Procedures, forms and training program
completed
3. Pilot site: RWJ – 003 Site (Mod. Complexity)
trained. Testing has begun.
Prepare to transition existing
Lab-based 4th generation testing
to POC-based 4th generation
tests
1. Approach existing Lab-based
4th gen. sites and their nonRWJ Bioanalytical Lab Directors
regarding interest in licensing
Determine prior to CLIA-Waiver
2. Consider using Determine
Combo as an orthogonal
confirmation expediting
identification of AHI
1. Requests initiated to:
Transition selected POC 2nd
generation testing (StatPak) to
POC-based 4th gen. tests
1. Approach higher prevalence
locations to transition initial
HIV screen to Determine
Combo
1. Requests accepted by:
• NJCRI – Newark
• Complete Healthcare
• Neighborhood Health
OVERALL GOAL
Prepare to Implement Point-ofCare 4th Generation Testing in
the absence of CLIA WAIVER
(Determine Combo)
•
•
•
Jersey Shore Medical Ctr. Neptune
Our Lady of Lourdes – Camden
St. Joseph’s Med. Ctr. - Paterson
Thanks!
53
Clients
Tested by
StatPak
Site
Number
Site Description
MONTH
6364
CTR Walk -IN
Jan.
87
6365
Jan.
6587
Emergency Room
Community
Outreach
6518
Lennard Clinic
Prelim
Positive
UniGold
Performed
UniGold
Confirmed
UniGold
Refusal
Number of
Discordant NOTES
6
6
6
0
0
43
0
0
0
0
0
Jan.
26
5
4
4
1
0
Jan.
0
1
1
1
0
0
6364
1/9/14
6364
1/15/14
Positive
Client
CTS
Number
18543
4
NEW
POS
6364
18548
1/27/14
7
6364
1/29/14
18549
2
18549
1/30/14
9
18584
1/8/14
2
18584
1/16/14
3
18585
1/22/14
0
6364
6587
6587
6587
6587
6518
Appt.
Date
1/17/1
4
x
18545
5
18548
1/27/14
4
6364
REENGAGED
ALREADY IN-Care
SITE
Number
IF R-2R
please
indicate
screeni
ng SITE
Number Date
x
X
X
X
X
X
X
X
1/15/1
4
1/27/1
4
1/30/1
4
1/29/1
4
1/30/1
4
1/8/14
1/17/1
4
1/22/1
4
Bus
Days to
Appt. Lab
KEPT Intake
No Show
Narrative
Client couldn’t link the same day because client didn’t have
any identification. Client stated it was lost; he had no
insurance which meant he had to apply for charity care
which requires I.D. Client returned on January 17 th with I.D.
and was linked to care the same day.
yes
5
yes
0
Yes
0
yes
3
Yes
0
Yes
0
Yes
1
Client was linked to care the same day. Client is currently in care.
Yes
1
Client was linked to care on the 17 th the next business day and is
currently in care.
Yes
5
1/29/14
18585
9
x
No
No
-
1/15/14
17387
7
x
1/24/1
4
Yes
7
Client was linked to care the same day. Client currently in care.
Client was linked to care the same day. Client currently in care.
Client stated he had to go out of town for a few days and
when he returned on the 30th he would commit to care.
Client came in on the 30th and was linked to care.
Client was linked to care the same day. Client currently in care.
Client was linked to care the same day. Client is currently in care.
Client was linked to care the same day. Client is currently in care.
Client refused linkage to care stated he wasn’t
interested. Patient Navigator will follow up with
client.
Client was a Rapid to Rapid referral from the Lennard
Clinic. Although client was tested and referred from
the Lennard Clinic on 1/15/14 he didn’t come in for
confirmatory testing until the 24th. Client stated he
couldn’t stay to be linked to care on the 24th and
•
•
•
GOAL: Simplify the process. Maximize
linkage and re-engagement.
More clients complete testing and are
linked to care on the same day using an
RTA.
Average time to lab intake for HIV+
positives is < 2 business days
2013 (344
POS from Apr
- Dec)
SUBTOTAL
New
Pos
175,630
RTA Testing Volume SINCE INCEPTION
5.7% Percent Refuse Western blot
2.5% Percent Refuse Unigold Verification
Percent of Prelim Positive Results not Verified by
3.9% Unigold
ReAlready in Client Denied Charity
Engaged
Care
Refused
Care
No Show
188
89
11
21
4
31
2013 RTA POSITIVE Distribution
1%
9%
6%
3%
New Pos
26%
55%
ReEngaged
Bus Days to
Lab Intake
1.8
RWJ Sites:
Non-RWJ Sites:
African
American Office
of Gay Concerns
Atlantic City
Health
Department
Burlington
County Health
Department
Camden AHEC
City of Trenton
City of Vineland
Complete
Health Care, Inc.
East Orange
Health
Department
Hispanic Family
Center
Eric B. Chandler
Health Center
FamCare
HiTops Inc
Horizon Health
Iris House
John Brooks
Recovery
Middlesex
County Public
Health
Department
Newark STD
Clinic
Liberation in
Truth
Newark
Community
Health Center
North Hudson
Community
Action
Corporation(9
sites)
Proceed
Visiting Nurse
Association of
Asbury Park
AtlantiCare
Mission Health
(Atlantic City
Corrections)
Camden County
Health
Departments
Bergen County
Health
Department
Buddies of NJ
Checkmate, Inc
JSAS
Catholic
Charities (Union
County Jail and
Hudson County
Jail)
Cumberland
County Health
Department
Hamilton
Township STD
Clinic
Hunterdon
Health
Department
Kean University
NAP Newark
NAP Trenton
New Horizon
Health Center
NJCRI
NJ React
Oasis Drop In
Center
Ocean County
Health
Department
Ocean Health
Initiatives
Paterson
Department of
Health
Robert Wood
Johnson Medical
School
Saint James
Social Services
Salem County
Health
Department
Well of Hope
William Paterson
University
South Jersey
AIDS Alliance
(OASIS) – in
licensing
process
Dooley House
Henry J. Austin
Health Center
Hyacinth
Foundation
La Casa Don
Pedro
Neighborhood
Health
Asbury Park
Community
Health
Center/Visiting
Nurse
Association
Cooper Medical
CenterEIP/Camden
County Jail
Atlantic County
Health
Department
Atlanti-Care
Regional
Medical Center
Cape May
County Health
Department
Cooper Medical
Center-ER
Gloucester
County Health
department
Hoboken Family
Planning- 3
sites
Hurtado Health
Center (Rutgers)
Jersey City
Medical Center
JFK Medical
Center
Our Lady of
Lourdes
Planned
Parenthood of
East Orange
Saint Joseph’s
Medical Center
Planned
Parenthood of
Mercer County
Saint Michaels
Medical Center
Morristown
Memorial
Hospital
Planned
Parenthood of
Central NJ
Raritan Bay
Medical Center
Newark Beth
Israel
Ocean County
Family Planning
Greater
Northern Jersey
Planned
Parenthood (10
Sites)
Monmouth
Regional
Medical Center
Planned
Parenthood
Metro
Planned
Parenthood of
Southern NJ
South Jersey
Family Medicine
( 7 sites)
Trinitas Hospital
University of
Princeton Health
Center (McCosh
Infirmary)
Women’s Health
& Counseling
Center Somerville
University
Hospital Newark ER &
STOP
Zufall Health
Planned
parenthood of
Hamilton
Saint John’s
Clinic
ARTICLES: Since 2004 - 16
1.
Paul SM, Cadoff EM, and Martin E. Rapid Diagnostic Testing for HIV – Clinical Implications. Clinical Virology and Infectious Disease. 2004.
2.
Paul S, Cadoff E, and Martin E. Rapid Diagnostic Testing for HIV: Clinical Implications of a New Diagnostic Tool. New Jersey AIDSLine. 2005; 1:3-9.
http://ccoe.umdnj.edu/online/AIDSLine/06HC02-DE02/contents/article.htm
3.
Paul S, Cadoff E, Martin E, Wolski M, Nichol L, Williams R, Harvey-Talbot M, Bruccoleri P, Maung A, Martin R, and Berezny L. Rapid HIV Testing in New Jersey Hospital Emergency
Departments. New Jersey AIDSLine, 2005:2(1):15-16.
4.
Shah MB, Paul SM, Bishburg, E, and Martin EG. Update on HIV and Hepatitis C Virus Co-Infection. New Jersey AIDSLine. 2(2): 3-10, 2005.
http://ccoe.umdnj.edu/online/AIDSLine/07HC08-DE02/contents/index.htm
5.
Gentz M, Paul SM and Martin EG. 2(4): 4-11, 2006. Hepatitis B and HIV Co-infection. New Jersey AIDSLine, http://ccoe.umdnj.edu/online/AIDSLine/08HC02/index.htm.
6.
Jafa K, Patel P, MacKellar DA, Sullivan PS, Delaney KP, Sides TL, Newman AP, Paul SM, Cadoff EM, Martin EG, Keenan PA and Branson BM for the OraQuick Study Group. (2007)
Investigation of False Positive Results with an Oral Fluid Rapid HIV-1/2 Antibody Test. PLoS ONE 2(1): e185. doi:10.1371/journal.pone.0000185.
http://www.plosone.org/article/fetchArticle.action?articleURI=info%3Adoi%2F10.1371%2Fjournal.pone.0000185
7.
Paul SM, Martin RM, Lin Y, Lu SE, Cadoff EM and Martin EG. Voluntary Rapid HIV Testing in Emergency Departments in New Jersey. Garden State Focus. 53(3): 23-25,
November/December 2006.
8.
Cadoff EM, Salaru G, Marone R, Gaur S, Paul SM and Martin EG. Integrating Rapid HIV Testing in Emergency Care Improves HIV Detection. Point of Care. 6(3): 1-7, 2007.
9.
Martin, EG and MA Newton. Rapid HIV Testing. In Czech and Slovaks in an International and Global context: Proceedings of the 23 th SVU World Congress. Editors: M. Rechcigl, V.
Papusck and M. Bauer. Univ. of S. Bohemia, 2008, 537-542.
10.
Paul SM and Martin EG. HIV Test Recommendations, Assay Selection. ADVANCE for Administrators of the Laboratory, 17(7): 86-92, 2008.
11.
Paul, SM and Martin, EG. HIV Testing Update. New Jersey AIDSLine, 9(1):14-28, 2009.
12.
Wesolowski1 LG, Ethridge SF, Martin EG, Cadoff EM and MacKellar DA. Rapid Human Immunodeficiency Virus (HIV) Test Quality Assurance Practices and Outcomes among
Testing Sites Affiliated with 17 Public Health Departments. Journal of Clinical Micro. October 2009 47: 3333-3335; doi:10.1128/JCM.01504-09. Epub 2009 Aug 19.
13.
Martin EG, Salaru G, Paul, SM and Cadoff EM. Use of a Rapid HIV Testing Algorithm to Improve Linkage to Care. Journal of Clinical Virology. 2011. Dec; 52 Suppl 1:S11-5. Epub
2011 Oct 7. PMID: 2198325
14.
Stevinson K., Martin EG, Marcella S, Paul SM. Cost Effectiveness Analysis of the New Jersey Rapid Test Algorithm for HIV Testing In NJDHSS Funded Testing Sites. Journal of
Clinical Virology. 2011. 52S: S29-33. Epub 2011 Nov 9. PMID: 22078147
15.
Martin EG. Current US HIV Public Health Strategies: Reflections on an Era of Globalization and Transatlantic Collaboration. Proceedings of the 26th SVU World Congress. Volume
1. Editors: Z. David, K. Raska and E.G. Martin. Czechoslovak Society of Arts and Sciences (SVU). 2012. ISBN 978-0-615-80114-8
16.
Martin, EG, Salaru G, Mohammed D, Coombs R, Paul S and Cadoff E. Finding those at risk: AHI in Newark, NJ. Journal of Clinical Virology. 58S (2013) e24– e28
http://dx.doi.org/10.1016/j.jcv.2013.07.016
17.
Mohammed DY, Martin EG, Sadashigie C, Jaker M, and Paul SM An Anonymous Unlinked Survey of the Sero-Prevalence of HIV/HCV antibody in an Urban Emergency Department’
Journal of Clinical Virology. 58S (2013) e19– e23. http://dx.doi.org/10.1016/j.jcv.2013.08.025
Since 2005 ABSTRACTS: – 44 absracts – 29 posters - 15
PLATFORM PRESENTATIONS: