Bridging the Gap: Conference Record [Abstract book, International Conference on AIDS (12th: 1998: Geneva, Switzerland)]

868 Abstracts 43105-43109

12th World AIDS Conference

in persons with heterosexual risk (AOR = 0.4, 95% Cl 0.3, 0.6). The trend of
increasing early detection with higher educational level continued to be significant.
Conclusion: Our findings indicate an overall low level of early HIV detection
and suggest that major sociodemographic and behavioral disparities exist in the
liklihood of early detection in Los Angeles. These differences have important
implications for community HIV transmission and for individual health. Aggressive
efforts are needed to expand HIV testing and early detection, with linkages to
treatment and behavioral intervention programs, for minorities, women, heterosexuals, younger age groups and persons of lower education.
137* /43105 Unawareness of HIV seropositivity before AIDS
diagnosis in Europe
Francoise F. Hamers, M.C. Delmas, J. Alix. European Centre for Monitoring of
AIDS 14 Rue Val D'Osne St. Maurice, Cedex, France
Background: For HIV-infected persons, awareness of seropositivity may be associated with favourable behaviour changes and is a prerequisite for early HIV
treatment. We sought to assess at what point in time, persons with AIDS learned
that they were HIV-infected (HIV+).
Methods: We examined European AIDS surveillance data on cases diagnosed
and reported in 1996 among homo/bisexual men (HBM), injecting drug users
(IDU) and heterosexually-infected persons (HET) in countries in which the date of
first HIV+ test is routinely available and >50 cases were diagnosed in the selected
period and transmission groups. The median time between HIV diagnosis and
AIDS diagnosis and the proportion of persons not diagnosed as HTV+ prior to
AIDS (late test) were determined. Multivariate logistic regression was used to
assess factors independently associated with a late test.
Results: Of the 8082 AIDS cases diagnosed in 11 selected countries, the
median time between HIV diagnosis and AIDS diagnosis and the proportion not
diagnosed as HIV+ prior to AIDS were respectively 4.5 years and 21% overall
(IDU: 7.5 years, 9%; HBM: 3.5 years, 25%; HET women: 3 years, 24%; HET men:
6 months, 41%). In a multivariate logistic model including age, sex, transmission
group, and country, HBM (adjusted odds ratio [aOR]: 3.8), HET women (4.0), and
HET men (8.7) were significantly more likely than IDU women to have been tested
late; for IDU men, the aOR (1.3) was not statistically different from 1. Compared
with persons with AIDS in Belgium, those in Italy (aOR: 1.9), France (2.1), Germany (2.7), Poland and United Kingdom (3.7), Austria (4.0), Switzerland (4.3),
and Ukraine (23) were significantly more likely to have been tested late; aOR
associated with Denmark (1.6) and Sweden (1.7) were not statistically different
from 1.
Conclusions: This study suggests that a large proportion of HIV infections remains undiagnosed before AIDS onset, particularly in non-IDU heterosexual men,
with large differences across countries. Differences between sub-populations in
the awareness of their seropositivity depend on the rate of HIV testing among
persons at risk for HIV infection and the stage of the HIV epidemic. Efforts should
be made to offer counselling and testing to a maximum number of persons at
increased HIV risk, particularly in view of new combination therapies.
43106 New testing technologies to enhance HIV prevention:
Evaluation of oral mucosal transudate-based HIV testing
Liisa Randall1, R.S. Pope1, M. Lapinski2, K.V. Hunt3, B. Branson3. 1Michigan
Dept of Community Health, HAPIS/MDCH PO Box 30195, Lansing Ml 48909;
2Michigan State University East lansing, Ml; 3Centers for Disease Control and
Prev Atlanta GA, USA
Issue: HIV testing is a key strategy for both primary and secondary prevention
of HIV infection. Serum collection serves as a disincentive to testing for some
individuals. Serum-based testing limits the contexts in which HIV testing can be
provided.
Project: The Michigan Department of Community Health implemented testing,
using oral mucosal transudate (OMT) technology, in community-based settings
beginning in March, 1997. OMT testing was intended to enhance access and acceptability of HIV testing in at-risk populations. An evaluation of the OMT initiative
assessed the: (1) extent to which OMT technology increased use of HIV testing
among at-risk populations by addressing perceived and practical disincentives
and (2) cost-effectiveness of OMT-based testing. Quantitative and qualitative
methods, including in-depth interviews with providers and clients, were used.
Results: HIV testing using oral mucosal transudate testing has be extremely
well received by both clients and providers. Field-based counseling and testing,
using OMT testing affords greater access to at-risk populations. Within the first
three months of implementation, the number of injecting drug users (IDUs) tested
for HIV increased by 300 percent. The proportion of individuals HIV seropositive
individuals identified through OMT testing was double that (2 percent) of that
identified through serum-based testing programs. Provisional findings suggest
that OMT testing is cost-effective compared with serum-based testing.
Lessons Learned: New HIV testing technologies can enhance the effectiveness of HIV testing as a prevention strategy by removing disincentives to testing
and expanding the contexts in which testing can be provided. Adoption of new

technologies requires consideration of the contexts in which testing is provided
and the type and quality of counseling and supportive services offered.

43107 Repeat HIV antibody testing among men who have
high-risk sex with men in San Francisco
James Dilley1, B. Adler1, W. McFarland2, W. Woods2, J. Sabatino1, J. Rinaldi1,
T. Lihatsh1. 1Univ Cal San Fran AIDS Health Project Box 0884 San Francisco
CA 941439-0884; 2Center For AIDS Prevention Studies, USA
Background: Repeat HIV antibody testing has been noted among men who
have sex with men (MSM) in several recent studies. However, the role of repeat
testing in reducing high risk behaviors or maintaining safer behaviors is not well
understood. We sought to further describe patterns of testing and risk related
behaviors among repeat anonymous testers as part of a prevention intervention
study.
Methods: MSM (N = 93) were recruited for a counseling intervention study
when scheduling an anonymous HIV antibody test. Participants were non-IDU,
had at least one previous test, were HIV negative at their prior test, and had
unprotected anal intercourse with another male who was positive or of unknown
status within the last year. Subjects were asked about their prior testing history
and risk related behaviors.
Results: On self-report, subjects identified themselves as "regular" (59%) or
"non-regular" (41%) repeat testers. Among regular testers, the most common
testing schedule was every 6 months (58%) followed by every year (33%). Compared to non-regular testers, regular testers had tested more times in the past
(median 7 vs. 4 times, p < 0.001), were older (median 34 vs. 32 years, p =
0.009), were more likely to be white (82% vs. 59%, p = 0.012), and were less
worried about already being infected (p < 0.001). While both groups reported
equal numbers of episodes of unprotected anal sex, regular testers reported a
greater number of partners (median 5 vs. 3, p = 0.004) in the last 12 months.
Regular repeat HIV testers are not simply worried, but continue to be at risk
for infection. Recognizing that repeat testing is not necessarily inappropriate,
we recommend: 1) determination of whether repeated counseling and testing is
effective in maintaining safer behavior; and 2) evaluation of targeted counseling
interventions for this population.
43108 Using risk assessment to target HIV testing is not
worthwhile for an STD clinic
Bernard Branson, Z. Chen. CDC 1600 Clifton Road E46, Atlanta, GA 30333,
USA
Objective: To determine if client self-administered risk assessment can be used
to improve targeting of HIV counseling and testing services in an STD clinic.
Methods: We studied computerized HIV test records from Prince George's
County Maryland STD clinic from 1993 to 1996. Logistic regression models were
developed to identify characteristics predicting persons with a positive HIV test
by using demographic and behavioral information collected during pretest counseling in 1993 and 1994. We then tested these models using 1995 data. In 1996,
patients were asked to complete a one-page self-administered risk assessment.
Using the models developed earlier, we compared the predictive value of this
self-assessment to that of the counselors' risk assessment from the same patient.
Results: Of the 12,038 patients studied from 1993 and 1994, 133 (1.1%)
tested HIV-positive. Eight risk behaviors and age were used to develop screening
models for targeting HIV testing. Applying these models to 1995 data, offering
HIV tests to persons with any risk behavior would identify 40% of the positives
by testing 11% of the patients; by also testing anyone over age 23, we would
identify 90% of the positives by testing 62% of the patients. In 1996, 2,288 patients completed the self-administered HIV risk assessment, of whom 25 (1.1%)
tested HIV positive. More patients reported one or more of the 8 risk behaviors
by self-assessment [216 (9.4%)] than by interview [172 (7.5%)]. However, if risk
assessment had been used to target HIV testing, either technique for eliciting risk
information would have identified only 7 (28%) of the HIV-positive persons.
Conclusion: Risk assessment was not useful for further targeting HIV testing
in an STD clinic population because it failed to detect many HIV positive persons.
Self-administered risk assessment was as effective as interview for eliciting risk
behaviors, and may be a useful screening tool for identifying high-risk persons,
and focusing counseling efforts.
135*/43109 1 Performance of a rapid HIV testing algorithm for
same day results at the AIDS Information Centre,
Uganda
Tephy Mujurizi1, M.G. Alwano Edyegu1, B. Biryahwaho2, E. Marum3,
R. Downing3, M. Rayfield3, P. Kataaha4. 1AIDS Information Centre PO Box 1044,
Kampala; 2Uganda Virus Research Institute (UVRI) Kampala; 3CDC/Uganda
Virus Research Institute Entebre; 4Nakasero Blood Bank Kampala, Uganda
Background: The AIDS Information Centre has been offering HIV counselling
and testing (CT) since 1990. Previously the laboratory testing was being done at
the National Blood Bank (NBB) and results given to clients after two weeks; about
25% failed to receive their results. During 1996, evaluation of various tests were
conducted and a rapid test algorithm (RT) was selected which is a combination of

Capillus HIV 1 & 2, as a screening test; Serocard HIV 1 & 2 as a second test for
all samples testing HIV+ on Capillus; and Multispot HIV 1 & 2 as a "tie breaker"
for samples that tested HIV+ on Capillus but HIV- on Serocard.
Methods: The performance of this algorithm for the period February to September 1997 was analyzed and compared to a randomly selected control batch of
5% of all negatives and 10% of all positives which were tested on Wellcozyme
HIV 1 + 2 (ELISA) at NBB.