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DPH reports progress with new generation of early detection HIV testing


Massachusetts among first states to make new test available for community HIV testing

BOSTON — The Massachusetts Department of Public Health today announced that it has tested 7,620 samples over the past year, using a new, 4th generation HIV test that detects early cases of the infection weeks sooner than previous tests, at a time when the virus is at the greatest risk of transmission.

DPH was one of the first states in the nation to implement the new 4th generation test, and the first state to make it widely available to community health providers. The Department anticipates that the test will eventually become a clinical standard and widely offered in private health care settings.

“This new generation test is a significant scientific advance in the fight against the spread of HIV,” said DPH Commissioner Cheryl Bartlett. “The Massachusetts Department of Public Health saw the potential public health value of this new test as it was being developed. Once it was approved, DPH was poised to put the test into place as quickly as possible and serve as a model for the nation.”

The HIV Lab at the Bureau of Laboratory Sciences, which confirms HIV testing done by medical providers, began using the latest HIV test in June 2012.

Through prevention and care initiatives, and with the support of the Patrick Administration, Massachusetts continues to see the largest decline in new HIV infections of all of the states, down 45% between 2000 and 2010 across racial/ethnic categories and modes of exposure. Much of this decline can be attributed to the policy and statutory developments surrounding Massachusetts’s health reform efforts. Massachusetts has expanded its Medicaid coverage, including being the first state in the nation to enable all income-eligible persons with HIV to access medical care through MassHealth, established Commonwealth Care to subsidize the insurance premiums of low-income persons, and expanded its commitment to its extensive community health center system. Recent research has established that maintenance in high quality medical care can lead to the suppression of HIV to undetectable levels, and that this in turn can dramatically the transmission of HIV. Massachusetts is gaining the public health benefits and health care cost savings of its health policy advances. The rest of the nation now has the opportunity, under President Obama’s Affordable Care Act, to follow suit.

Dr. Michael Pentella, director of the Hinton State Laboratory, Dr. Barbara Werner, a DPH consultant and former senior scientist at the Hinton Lab, and Dr. Liisa Randall, director of health care planning in the Office of HIV/AIDS, served on the panel that developed the national standards for using and interpreting the new test.

DPH currently offers the test to providers that have contracts with the Department to provide HIV testing, including community-based sites that see some of the highest-risk individuals. Blood samples are sent to the Bureau of Laboratory Sciences at the Hinton State Laboratory in Jamaica Plain.

HIV laboratory tests have evolved over the years, with each version being more sensitive to indicators of HIV infection, shortening the time from infection to detection. The prior tests relied on the detection of antibodies for HIV, meaning a person had to be infected for several weeks or months before receiving a positive test result.

The so-called 4th generation test looks not only for HIV antibodies, but also for proteins from the virus itself. This allows detection within 10 days to two weeks of infection, even before the infected person has shown antibodies to HIV. This period is known as the acute infection phase, a time when the virus is present is large quantities in the blood and body fluids, increasing dramatically the chances of transmission through risky behavior.

A person in the acute HIV infection phase has a particular opportunity for HIV treatment. Even a short period of aggressive treatment during this phase can permanently affect the “set point” of the virus and improve their ability to control the infection in the future. Also importantly, since levels of virus in the body are at their highest during this period, a person needs to be counseled immediately about the risk of transmission, and their partners need to be contacted for priority testing.

The adoption of this new test required significant changes in how testing clients are counseled, how blood samples are sent to the Hinton State Laboratory, how results are communicated to providers, and how patients and their partners are contacted and counseled by state Disease Intervention Specialists.

This DPH project was a collaboration between the State Lab, the DPH Office of HIV/AIDS contract managers, community-based and clinical programs, and the DPH Division of STD Prevention. The success of the program was the subject of an oral presentation at a CDC-sponsored HIV/HCV diagnostics conference in Atlanta.

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