NJHIVCapacity Building Workshop

for Division of Addiction Services

Treatment Centers

December 8, 2009

New Jersey and AIDS

New Jersey is a high prevalence state 5th in the US in cumulative reported

AIDS cases 3 in cumulative reported pediatric AIDS

cases 1st in proportion of women with AIDS

among cumulative reported AIDS cases

Why test?

People who know they are infected with HIV are more likely to practice risk-reduction.

More people learn their HIV status, and can be referred for treatment, prevention programs, and social services.

HIV cases among IVDU

Historically, 41% of HIV cases in New Jersey are among IVDU

MSM

IVDU

MSM/ IVDU

Contactat risk

Other

New Jersey Rapid HIV Testing

Counseling sites started in mid-1980s

Testing added in late 1980s Rapid testing added in 2003 70 laboratory licenses

Health Departments, STD clinics, CBOs, Faith-based initiatives,

Hospitals,Mobile vans, Field counselors

23 Emergency Departments

2006 ASTHO Vision Award

New Jersey Rapid HIV Testing

Inventory control & /validation Training Ongoing QA

Temperature monitoring QC quality control Proficiency Testing

Regular monitoring Review of logs Site visits “Report card”

2 MD, 1 PhD, 1 manager, 6 techs

HIV detection

HIV Serotypes

HIV-1

Group MGroup O

? Group N

HIV-1

Group MGroup MGroup OGroup O

?? Group NGroup N

HIV-2

?

HIV-2

??

HIV Infection

AIDSAcute Infection Silent Infection

1-3 yearsWeeks after infection 5-10 years

Symptoms

Antibody by 3rd gen EIA

Antigen

Antibody by Western Blot

Antibody by 1st gen EIA

RNA / NAAT

HIV “Window”

Early in infection, antibody test will be negative.

Repeat testing is necessary RNA testing may shorten this

window period

A

BC

D

August 4: HIV Ab Negative

September 10: not tested

October 31:HIV EIA Positive; Western Blot indeterminate

September 30: not tested

HIV Infection

AIDSAcute Infection Silent Infection

1-3 yearsWeeks after infection 5-10 years

Symptoms

Antibody by 3rd gen EIA

Antigen

Antibody by Western Blot

Antibody by 1st gen EIA

RNA / NAAT

HIV Detection

Currently test for antibody production

Confirmatory test in state laboratory

RNA testing in pilot programs

NJ HIV testing

68,000 tests 3 years ago Over 90,000 tests this year

HIV cases among IVDU Historically, 38%

of new HIV cases were among IVDU

In the last year, only 8% of reported HIV cases were from IVDU

0

5

10

15

20

25

30

35

40

Male Total

Historic

Recent

New York City IVDU: 1990s >30% seropositivity 2000s 5-6% seropositivity Most cases are old New cases < 1% per year

New York City IVDU: HIV incidence parallels Herpes

Simplex Virus infection HIV incidence does NOT parallel

Hepatiti C Virus infection IVDU population engages in high-

risk sexual activity

Goal is for twice a year HIV testing in drug abuse population

Goal is for twice a year HIV testing in drug abuse population

SAMHSA initiatives in place to promote HIV prevention activities

Award of ~$250,000 in New Jersey from SAMHSA

Today’s Focus

Help DAS programs catch up to DHAS programs in HIV testing and prevention efforts

Help DAS programs to be in a position to apply for supplemental SAMHSA funding

Work together to increase HIV testing