NJHIV Rapid HIV Testing Program
HIV Testing Algorithms
– A Long Journey –
Eugene G. Martin, Ph.D.
Professor – Pathology & Laboratory Medicine
UMDNJ – Robert Wood Johnson Medical School
Co-Director, NJ HIV
NJHIV Rapid HIV Testing Program
AGENDA
• Background – HIV Testing 1985 -2013
• Overview of Current HIV Testing Algorithms
– Testing performed at public sites – LICENSURE DETERMINES OPTIONS
– Testing preformed in hospital laboratories – MIXTURE OF LAB-BASED & POCTBASE
– Testing performed in national laboratories – GAMUT with use of reflex testing
driven by results
• CDC updates and revisions over the past few years:
– CDC/APHL DIAGNOSTIC CONFERENCES 2004-2012
– CDC TASKFORCES: HIV LAB & POCT TESTING, AHI DEFN
– DRAFT HIV DIAGNOSTIC GUIDELINES 2013
• Testing Results
– Result and Interpretation.
• THE connection:
– Linkage to Care
NJHIV Rapid HIV Testing Program
THE CONTEXT
BACKGROUND
NJHIV Rapid HIV Testing Program
CDC estimates
• 1.2 million people (US) are living with HIV
• One in five (20%) are unaware of their infection
• While relatively stable for several years the rate of ‘new’ HIV
infection rate is substantial 
– About 50,000 become infected each year
• Prevalence is increasing because of anti-retroviral
therapy.
• The problem infectivity is largely a function of viral load
and risk encounters
NJHIV Rapid HIV Testing Program
21% Undiagnosed
31% Not linked/delayed
41% Not retained
19%-29% VL<50 c/mL
Gardner et al. Clin Infect Dis 2011;52; Marks et al. AIDS 2010;24
NJHIV Rapid HIV Testing Program
Why Rapid Testing Algorithms are Need in Public Health?
Disposition of Confirmed HIV + Clients
326
350
244
300
250
200
82
150
47
100
11
50
0
Number
Confirmed HIV +
Referred to NAP
Result retuned to client
Found by NAP
Did Not Receive Results
• Problem
– Preliminary Positive
clients fail to return for
results (25.2%)
– NAP succeeds ONLY 20%
of the time in locating
these clients
• Solution
– Confirmatory testing onsite, same day
– In use, high prevalence
areas worldwide
NJHIV Rapid HIV Testing Program
Key Questions
1. What strategies will get more people to
learn their HIV status?
2. How do we get more infected individuals
into care AND encourage earlier treatment?
3. How does improved ART impact efforts to
reduce transmission?
NJHIV Rapid HIV Testing Program
Recently Large Change in Focus. Why?
1. 40% of HIV infections occur in the earliest
stages of the disease
2. New 4th generation HIV Tests are allowing us to
identify infected individuals when they are most
infectious!
3. Earlier treatment preserves immune function
and improves morbidity
4. LINKAGE TO CARE – Underpins prevention &
treatment ...
•
•
Test to Treat
Treatment as Prevention
NJHIV Rapid HIV Testing Program
Transmission is a function of viral load!
5
HIV RNA in
Semen
(Log10
copies/ml)
Risk of Transmission Male to Female - Blue
Evolving Reflects Genital Viral Burden – Yellow
Opportunity! Effect of ART – Theoretical - Red
4
(1/1001/1000)
(1/30-1/200)
3
(1/1000 –
1/10,000)
(1/500 1/2000)
HIV Screening before 2012
2
Acute
Infection
Asymptomatic
Infection
HIV Progression
Cohen and Pilcher, JID 191:1391, 2005
AIDS
NJHIV Rapid HIV Testing Program
AHI – Acute HIV Infection
•
•
70-80% symptomatic, 3-12 weeks after
exposure
Surge in viral RNA copies to >1 million
–
Recently we had one 10 million copies!!
•
•
CD4 count drop to 300-400 w/ rebound
Recovery in 7-14 days
•
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 AHI is short (typically 3-4
weeks), studies have consistently shown
that 40-50% of new HIV transmissions
are caused by onward transmission from
an individual with AHI.
•
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
NJHIV Rapid HIV Testing Program
HIV Testing 1983  Present Day
• 1980s -T-cell assays
• 1985 – HIV Antibody testing – Lab-based –
– Enzyme Immunoassays: 1st Gen
•
•
•
•
1987 – HIV Western Blot criteria – Why?
1991 – Improved EIA: 2nd Gen
1996 – Oral mucosal transudate testing- OraSure
2003 – Rapid testing (blood and then oral transudate)
• Current: Rapid 3rd gen assays and laboratory 4th gen assays
with available nucleic acid amplification testing (NAAT)
• Current: Rapid 4th gen assays with both antibody and antigen
p24 testing (Determine, FDA approved)
• Future: Rapid CD4/CD8 assays and rapid viral load assays
NJHIV Rapid HIV Testing Program
HIV Infection
Symptoms
Antibody
by 1st gen EIA
Antibody
by Western Blot
Antibody
by 3rd gen EIA
Antigen
RNA / NAAT
Acute Infection
Silent Infection
AIDS
Weeks after infection
5-10 years
1-3 years
NJHIV Rapid HIV Testing Program
THE CONTEXT
SEROLOGIC MARKERS
DURING HIV-1 INFECTION
NJHIV Rapid HIV Testing Program
Assay Reactivity during Early HIV
NJHIV Rapid HIV Testing Program
Typical HIV Serologic Profile
NJHIV Rapid HIV Testing Program
Viremia During Early HIV Infection
HIV Antibody –
22 Days
3rd
Generation
P24 Ag
16 Days
Pooled NAAT
14 Days
11 Days
10
ANTIBODY WINDOW
Ramp-up Viremia Doubling
Time
16
22 DAYS
= 21.5 hrs
•
Peak Viremia
•
Viral set-point
•
WINDOW
106 – 108 gEq/mL
102 – 105 gEq/mL
–
–
–
–
Individual NAAT
0
•
Antibody – 22 Days
Antigen – 16 Days
Pooled NAT – 14 Days
Individual NAT – 11 Days
NJHIV Rapid HIV Testing Program
HIV Tests are NOT all equal
NJHIV Rapid HIV Testing Program
BACKGROUND
• Testing 1985-2003
• CLIA - Waived Rapid HIV antibody tests:
– Orasure
• Oral
• Fingerstick
– Clearview
– Trinity
– Insti (2011) – 1 Minute to Read
• 2010  4th generation testing
– Laboratory-based (CLIA – MOD. COMPLEXITY) :
• Abbott Architect Combo HIV1/2 Ag/Ab
• Biorad
– Rapid HIV Antigen/Antibody tests (2013) (PENDING CLIA WAIVER)
• Alere Determine (HIV1/2 Ag/Ab)
NJHIV Rapid HIV Testing Program
What’s it all about?
• SCREENING versus DIAGNOSIS
• SCREENING FOR HIV  Focus on ‘LINKAGE TO CARE’
– Orthogonal Confirmation
– “Presumptive Diagnosis” – Pending additional testing:
• CD4
• NAAT Testing – Aptima
• LAB-BASED DIAGNOSIS:
– Manufacturer’s Package Insert couple with a confirmatory step:
NJHIV Rapid HIV Testing Program
MMWR September 22, 2006 / 55(RR14);1-17
Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings
Bernard M. Branson, MD1 H. Hunter Handsfield, MD2
Margaret A. Lampe, MPH1Robert S. Janssen, MD1
Allan W. Taylor, MD1Sheryl B. Lyss, MD1Jill E. Clark, MPH3
1Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (proposed)
2Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (proposed) and University of Washington, Seattle,
Washington
3Northrup Grumman Information Technology (contractor with CDC)
•
•
•
Routine HIV testing for adolescents and adults in health-care settings
Test everybody unless specifically denied
Screen for HIV regardless of prevalence (as effective in very low prevalence
as in high prevalence areas).
• High-risk individuals at least annually, recommended every 6
months
• Drug users are by definition high-risk
–
–
–
–
Addiction treatment centers
Methadone programs
Needle exchange programs
…strange advantage – patients keep returning to the center, so counseling,
linkage to care or additional tests can be performed
NJHIV Rapid HIV Testing Program
To Date: FDA Has Approved 2
4TH GEN. LAB BASED ASSAYS
NJHIV Rapid HIV Testing Program
FDA Approval – 4th gen. Lab Based Assays:
1.
18 June 2010 – Abbott Architect HIV Ag/Ab Combo Assay
–
–
2.
First diagnostic test approved by FDA for use in children as young as 2 years
of age, and pregnant women.
Specific for the detection of the HIV-1 p24 antigen , as well as antibodies to
HIV-1 groups M and O, and as antibodies to HIV-2.
22 July 2011 - GS HIV Combo Ag/Ab EIA, (Bio-Rad
Laboratories)
•
Neither test distinguishes between HIV-1 p24 antigen, HIV-1 antibody, or
HIV-2 antibody in a sample, but they are sensitive to the presence of
p24Ag.
•
“Patients … who identify a specific risk occurring more that 4 weeks previously,
should not be made to wait three months (12 weeks) before HIV testing. They
should be offered a 4th generation laboratory HIV test and advised that a negative
result at 4 weeks post exposure is very reassuring/highly likely to exclude HIV
infection. An additional HIV test should be offered to all persons at three months
(12 weeks) to definitively exclude HIV infection. Patients at lower risk may opt to
wait until three months to avoid the need for HIV testing twice.
NJHIV Rapid HIV Testing Program
Study design
• 9150 samples at four U.S. clinical trial sites, using three kit lots.
Unlinked samples were from routine testing, repositories or
purchased from vendors.
Results
• GS HIV Combo Ag/Ab EIA detection in samples from individuals in
two separate populations with acute HIV infection was 95.2%
(20/21) and 86.4% (38/44). Sensitivity was 100% (1603/1603) in
known antibody positive [HIV-1 Groups M and O, and HIV-2]
samples.
• HIV-1 seroconversion panel detection improved by a range of 0–20
days compared to a 3rd generation HIV test. Specificity was 99.9%
(5989/5996) in low risk, 99.9% (959/960) in high risk and 100%
(100/100) in pediatric populations.
NJHIV Rapid HIV Testing Program
NJ Facilities with 4th Gen. HIV testing – Oct. 2013
CentraState Medical Center
901 West Main Street,
Freehold TWP NJ 07728
Jersey Shore University Medical Center
1945 New Jersey 33
Neptune, NJ
St. Barnabas Medical Center
94 Old Short Hills Rd.
Livingston, NJ 07039
Newark Beth Israel Medical Center
201 Lyons Ave.
Newark, NJ 07112
St. Peter’s Medical Center
254 Easton Ave.
New Brunswick. NJ 08901
St.Francis Medical Center
601 Hamilton Ave.
Trenton, NJ
Our Lady Of Lourdes Medical Center
1600 Haddon Ave.
Camden NJ
VA East Orange
385 Tremont Ave.
East Orange NJ
Shore Memorial Hospital
1 E New York Ave.
Somers Point, NJ 08244
Hackensack University Medical Center
30 prospect ave.
Hackensack, NJ 07601
RWJ Hamilton
1440 Lower Ferry Rd.
Ewing twp, Nj
St, Josephs regional Medical center
703 Main Street.
Paterson, NJ 07503
UMDNJ
150 Bergen stHackettstown Medical Center
651 Willow Grove St.
Hackettstown, NJ 07840
Holy Name Medical center
718 Teaneck Rd.
Teaneck, NJ 07666
Manhattan Labs
25 riverside Dr.
Pine Brook NJ
NJHIV Rapid HIV Testing Program
NJHIV Rapid HIV Testing Program
HIV Rapid Screening Tests
CLIA-waived Complexity
Clearview StatPak
Trinity Uni-Gold
Clearview HIV1/2 Complete
Oraquick Rapid
NJHIV Rapid HIV Testing Program
NJHIV Rapid HIV Testing Program
Test develops in 20-40 minutes
NJHIV Rapid HIV Testing Program
Rapid HIV Testing Results
Trinity Unigold
Orasure Oraquick
NJHIV Rapid HIV Testing Program
3.5  4th Gen – Point-of-Care Test
NJHIV Rapid HIV Testing Program
•
•
All 7 false positive p24 Ag sera
were correctly identified by the
Determine Combo test as negative.
5/14 of the p24 Ag true positive
sera (early seroconversion) were
missed by the Determine Combo
test and tested negative for both
p24 Ag and antibodies
Even though there is a 64% improvement over a third generation (Ab only)
POCT, health care professionals should still be aware that the Determine
HIV-1/2 Ag/Ab Combo is not as sensitive as 4th generation Lab-based EIAs
in diagnosing primary HIV-1 infections!!
NJHIV Rapid HIV Testing Program
ALGORITHMS
• Laboratory-based
• Point-of-Care based
NJHIV Rapid HIV Testing Program
Perform 1st
Rapid:
Oraquick OR
StatPak
First rapid
HIV Negative
First rapid
HIV +
Negative for
HIV Antibodies
NJ RAPID TESTING ALGORITHM
PRELIMINARY
POSITIVE
ORTHOGONAL
PERFORM
2nd Rapid –
Trinity
Unigold
2nd rapid
HIV +
Collect Blood for HIV1 Western blot
(NJ PHEL)
White top tube for
possible NAAT: spin/
freeze
2nd rapid
HIV -
DISCORDANT
PROCESS
HIV Verified – Refer to
Care IMMEDIATELY
Notify NJ HIV
Clinicians for followup
White top tubes
picked up ->
Reference Lab
GOAL: 20 MIN
VERIFIED
RESULT SAME
DAY REFERRAL
GOAL: 96 HR.
DISCORDANT
RESOLUTION
NJ HIV Techs
pickup
process and
follow-up
NJHIV Rapid HIV Testing Program
“PRESUMPTIVE DIAGNOSIS”
 When Rapid HIV Tests are used as a part of an RTA,
a diagnosis can be made with a CONFIRMATORY
Western blot; OR by a second (but different
manufacturer’s) rapid test.
If the diagnosis is made by a second rapid:
 “Presumptive Diagnosis “ – and requires further
testing at the treatment site as a part of staging
the infection.
NJHIV Rapid HIV Testing Program
NOVEMBER, 2011
RTA MEETS CDC HIV CASE DEFINITION
Dear Colleagues:
Thank you for joining us on last week’s HICSB Quarterly Call. Attached is the letter discussed
during the call regarding the new HIV testing algorithms guidance issued by the Clinical
Laboratory and Standards Institute (CLSI). The letter affirms that these new algorithms meet
the current HIV case definition and provides instructions for recording a case diagnosed using
the new algorithms in eHARS.
We recognize these new algorithms represent a shift in surveillance practices. To help states
address these changes, HICSB is creating a list of Frequently Asked Questions (FAQs). Please
send your questions to Adria Prosser at ahp8@cdc.gov and cc your surveillance program’s CDC
epidemiology consultant.
Best regards,
H Irene Hall, PhD, FACE
NJHIV Rapid HIV Testing Program
Review of HIV-1 Confirmation testing WB/Aptima
• While Western blot (WB) is still widely considered a ‘gold
standard’
– No longer suitable, more sensitive assays in use already
• Issue aggravated by potential availability of Ag/Ab Combo rapid assays
• Cost. Also, cost dependent on TAT requirements i.e. if rapid TAT, cost increases (kit-based
assay)
– Serum sample
• Aptima
–
–
–
–
approved for diagnosis of HIV-1 (early AHI/ primary HIV, no antibodies yet)
Approved for confirmation of HIV-1 if antibody screen is positive
Lab based method, sensitivity similar to FDA approved viral load assays
Plasma sample (or conversely, Whole Blood if spun adequately)
NJHIV Rapid HIV Testing Program
Possible HIV CONFIRMATORY pathways:
1.
On-site RAPID3 with On-site RAPID3 verification (current RR algorithm)
2.
On-site RAPID3 with remote EIA3 or EIA4
•
EIA can serve as an orthogonal assay
3.
On-site RAPID3 with remote RAPID3
4.
On-site RAPID4 Antigen ONLY with remote Aptima
5.
On-site RAPID4 Antibody/Antigen (Lab-based or POCT) with an ON-SITE
RAPID3
Discordant results will be handled by same procedures by NJHIV staff/ docs
Still need sample collected for discordant resolution
–
–
•
If remote EIA/ rapid, need to get client back to site
–
–
–
•
Delay referral
Delay entry into care
Refuse confirmation possible for all remote tests
If on-site verification, referral to care faster, eliminates non-returners, blood draw refuse
NJHIV Rapid HIV Testing Program
Summary of Interpretation of HIV-1 Specimen Results
APTIMA HIV-1
RNA
HIV-1 Antibody
Result
Interpretation
A
Reactive
Repeatedly
Reactive
Confirmed HIV-1
infection*
B
Repeatedly
Reactive
Nonreactive
Possible acute/ primary
HIV-1 infection*
C
Nonreactive
Repeatedly
Reactive
Unconfirmed HIV-1
Positive**
D
Nonreactive
Nonreactive or Not
Done
HIV-1 RNA not detected
***
* The individual should be referred for medical follow-up and additional testing.
** Antibody results should be confirmed with Western blot or IFA.
*** A nonreactive test result does not preclude the possibility of exposure to or infection with HIV-1.
Sample requirements for Aptima (studies with alternative specimens, good results available):
•
•
•
1.6 mL frozen plasma (EDTA, lavender-top tube); 0.6 mL minimum
Alternatively, frozen PPT-potassium EDTA plasma (white-top tube) may be submitted.
Centrifuge blood, transfer plasma to a plastic screw-capped tube, and freeze within 6 hours of collection.
NJHIV Rapid HIV Testing Program
But an important question remains
• How often do we miss an early infection?
• How often do we screen an individual and tell
them they’re negative, when, in fact, they are
most likely to infect others?
NJHIV Rapid HIV Testing Program
•Screening for Acute HIV Infection in Newark, NJ
Eugene Martin1*, Debbie Mohammed2, Gratian Salaru1, Joanne Corbo1,
Michael Jaker2, Joan Dragavon4, Robert Coombs4, Sindy Paul3, and Evan
Cadoff1
–
1
2
3
4
UMDNJ – Robert Wood Johnson Medical School, Somerset, NJ 08873
UMDNJ – New Jersey Medical School
New Jersey State Department of Health and Senior Services, Trenton, NJ
University of Washington, Seattle, WA
•
Use of rapid HIV in conjunction with pooled NAAT allows assessment of
the burden of acute HIV infection (AHI) in a particular locale.
•
Clients offered NAAT testing after rapid HIV testing. Of those accepted
(~50%), specimens collected shipped to Univ. of Washington where
NAAT was performed.
•
8 AHI’s identified in 6785 specimens tested. Approximately 6.9%
increase in yield over AB + only
NJHIV Rapid HIV Testing Program
Reminder: 10 -14 Days Ramp-Up
Phase – Rapid Viral Replication
NJHIV Rapid HIV Testing Program
NAAT Testing of Antibody Negative Blood :
Results Nationwide
Program
Dates
Description
HIV Ab neg adults seen at
two STD clinics (6/06--3/08);
multiple venues 7/07-3/08)
Rapid
Tested
NAAT
Tested
HIV
Ab+
AHI
% HIV Ab +
% Inc in Yield
% Yield AHI
Maryland
6/06-3/08
North
Carolina
HIV Ab neg persons in
North Carolina seeking HIV
11/02-10/03
testing at 110 publicly
funded sites (n = 109,250)
Los
Angeles
2/04-4/04
NEWARK,
NJ
HIV Ab neg adults receiving
testing and counseling at
2/10 to 1/12
two high risk urban hospitals
in Newark, NJ
Seattle
King
County
9/03-1/05
HIV Ab neg MSM seeking
HIV testing through SeattleKing County (n = 3525)
3439
5
81
2.36%
6.17%
0.15%
10/02-1/04
2202 adults receiving HIV
testing and counseling at
three high risk urban sites in
Atlanta, Georgia
2136
4
66
3.09%
6.06%
0.19%
10/03-7/04
HIV Ab neg persons seeking
HIV testing at San Francisco
Municipal STD clinic (n =
3075)
2722
11
105
3.86%
10.48%
0.40%
Atlanta
San
Francisco
HIV Ab neg men seeking
HIV testing at three STD
clinics (n = 1712)
58925
7
1709
2.90%
0.41%
0.01%
108667
23
583
0.54%
3.95%
0.02%
1698
1
14
0.82%
7.14%
0.06%
8 116
0.94%
12390 6785
6.90% 0.12%
NJHIV Rapid HIV Testing Program
HIV Tests have come a long ways
NJHIV Rapid HIV Testing Program
Conclusions:
• NAAT tells us we’re missing of 6-8% of those infected
when we screen for antibodies!
• Those with the highest risk of infecting others are the
one’s being missed!!
• The same issues with patient return and process
completion occur with NAAT that occur with traditional
testing!!!
• Solution: EIA’s that pickup p24 Ag COULD pickup a
substantial proportion of the same population. A POCT
device could increase the pickup without losing the ability
to link patients to care.
NJHIV Rapid HIV Testing Program
Recommendations 2013 - CDC Diagnostics
Recommendations
1. Initiate screening with a 4th generation Ag/Ab combination immunoassay
(IA)
2. Reactive (repeatedly reactive) specimens should be tested with a 2nd
generation Ab IA that differentiates HIV-1 from HIV-2 antibodies.
(MULTISPOT)
3. Persons whose specimens are positive on the initial IA and antibody
differentiation IA should be considered positive for HIV-1 or HIV-2
antibodies and initiate medical care that includes laboratory tests such as
viral load, CD4, and antiretroviral resistance assays.
4. Specimens reactive on the initial IA and negative on the HIV-1/HIV-2 Ab
differentiation IA should be tested for HIV-1 RNA. A reactive result
indicates Acute HIV-1 infection.
5. Follow this same testing algorithm (beginning with 4th generation IA) for
specimens with a previous reactive rapid HIV test result.
NJHIV Rapid HIV Testing Program
Alternatives:
1. If 3rd gen HIV-1/2 IA as initial test: perform subsequent
testing specified in the algorithm.
2. If alternative 2nd Ab test is used (e.g., WB or IFA): If
negative or indeterminate, perform HIV-1 NAT; if HIV-1 NAT
is negative, perform Ab IA for HIV-2
3. HIV-1 NAT as 2nd test: if positive, HIV-1 infection; if
negative, perform HIV-1/HIV-2 Ab differentiation assay.
NJHIV Rapid HIV Testing Program
1.
Supersedes:
–
–
–
2.
Screens for both virologic and serologic markers of HIV infection
–
–
–
3.
Recommendations for Use of Western Blot (1989)
Recommendations for HIV-2 Antibody Testing (1992)
Protocols for confirmation of reactive rapid tests (2004)
Incorporates NAT to resolve discordant IA results
Identifies acute HIV-1 infection
Reduces indeterminate test results
All IA-positive specimens tested for HIV-2
–
–
–
Emphasizes sensitivity
For initial testing
During supplemental testing
4. Rare false-positive antibody test results might occur
– False-positive results would be discovered during subsequent laboratory testing
recommended as part of initial clinical evaluation
NJHIV Rapid HIV Testing Program
THE END
NJHIV Rapid HIV Testing Program
NJHIV – WHO WE ARE
• Rapid HIV testing support group
• Composed of laboratorians
– MD, PhD, MT, RN
• Department of Pathology and Laboratory Medicine at Rutgers
Robert Wood Johnson Medical School
• Built upon an existing Rutgers Robert Wood Johnson Medical
School, multi-facility, point-of-care-testing program
• Develop a centralized quality assurance process
• Management by board certified Pathologists, experienced
laboratory professionals, RNs and medical technologists
• Supervisory control through site coordinators
NJHIV Rapid HIV Testing Program
New Jersey Rapid Testing
RWJ Sites: 97 Non RWJ Sites: 64
Rapid HIV Testing NJ
RWJ sites:
60 Primary
24 satellites
13 mobile
Non RWJ site:
64 sites including 12 ERS
NJHIV Rapid HIV Testing Program
Sites, laboratories and point-of-care locations
supervised by the Department of Pathology at RWJMS
NJHIV
NJHIV
AtlantiCare Mission Health-Atlanitc County Corrections
Atlantic City Health Department
Bergen County Health Department
Burlington County Health Department
Camden AHEC
Camden County Health Department
Catholic Charities-Hudson & Union County Corrections
Check-Mate
City of Trenton
City of Vineland
Complete Health Care
Cumberland County Health Department
Dooley House
East Orange Health Department
Eric B. Chandler Health Center
FamCare
Hamilton Township STD Clinic
HiTops Inc.
Henry J. Austin Health Center
Horizon Health Center
Hunterdon County Health Department
Hyacinth Foundation
John Brooks Recovery (IHD)
Jersey Shore Addiction Services (JSAS)
Kean University
La Casa Don Pedro
Liberation In Truth Drop In Center
Middlesex County Department of Health
NAP
Neighborhood Health Centers
Newark Community Health Centers
Newark STD Clinic
NJCRI
N. Hudson Community Action Corporation Health Ctrs.
Oasis Drop In Center
Ocean County Health Department
Paterson Health Department
Proceed
Saint James Social Services
Robert Wood Johnson Medical School
Visiting Nurse Association of Central NJ
Well of Hope
William Paterson College
Hospitals /Laboratories
State Public Health Laboratories
Bayshore Community Hospital
Children’s Specialized Hospital, New Brunswick
Children’s Specialized Hospital, Mountainside
Robert Wood Johnson University Hospital
Robert Wood Johnson University Hospital at Hamilton
Southern Ocean County Hospital
University Behavioral Healthcare, Piscataway
Medical offices POCT
New Brunswick/Piscataway:
Chandler Health Center
Clinical Academic Building
Clinical Research Center
Cancer Institute of New Jersey
Medical Education Building
Monument Square
Icon Laboratories CRC
NJHIV Rapid HIV Testing Program
Division of Mental Health and Addiction Services (DMHAS)
Thanks To:
RWJMS
•
Evan Cadoff, MD
•
Eugene Martin, Ph.D.
•
Gratian Salaru, MD
•
Joanne Corbo, MBA, MT
•
•
•
•
•
Mooen Ahmed, MT
Claudia Carron, RN
Aida Gilanchi, MT
Nisha Intwala, MT
Franchesca Jackson, BS
•
•
Lisa May
Karen Williams
NJ DMHAS
• Adam Bucon
• Nancy Hopkins, MAS
• Mollie Greene
Site coordinators and counselors throughout New Jersey