HIV point-of-care testing in Ontario: Update to 2012

1. HIV point-of-care testing in Ontario: Update to 2012 Ashleigh Sullivan, Carol Swantee, Robert S. Remis HIV Laboratory, Public Health Ontario Public Health Agency of Canada Toronto, OntarioJune 13, 2013

2. Background: HIV point-of-care testing • INSTITM HIV antibody finger-prick test (bioLytical) • Negative result available immediately • Demographic and risk factor information on HIV requisition • Label affixed to requisition and sent to laboratory with* or without blood sample • Negative: Epidemiologic information only • Negative in window period with high risk exposure: Supplemental laboratory testing* • Reactive: Confirmatory laboratory testing* • Entered in Labware (laboratory information system)

3. POC testing in Ontario From September 4, 2007 to December 31, 2012 110,281 tests performed at46 sites Average ~1,900 tests per site (total) Median ~500 per site Majority of sites began POC testing in 2008 26,196 tests in 2012, i.e. ~7,000 tests per quarter

4. POC tests by quarter

5. POC tests by submission type, 2012 • Anonymous: 16,181 (62%) • Coded: 9,036 (34%) • Nominal: 979 (4%)

6. POC tests by age group and sex, 2012

7. POC tests by exposure category, 2012

8. Test results, 2012 POC tests 26,196 POC reactive 181 (0.69%) POC non-reactive 26,015 No samplesent20 HIV positiveat laboratory141 HIV negativeat laboratory20 HIV negativeas per POC test25,548 Window period467 HIV negativeat laboratory461 HIV inconclusiveat laboratory2 HIV positiveat laboratory4

9. Test “specificity” by year

10. HIV positivity rate by year

11. HIV positivity rate by age group and sex, 2012

12. POC versus standard testing, 2012 • POC positivity rate: 0.55% • Standard testing positivity rate: 0.17% • However, POC testing primarily conducted at anonymous HIV testing sites which historically have a positivity rate 4-fold higher than standard testing • With POC, anonymous testing in Ontario has increased by ~50% and constitutes most (~92%) of anonymous testing

13. HIV positivity rate by exposure category, 2012

14. Summary, 2012 • POC testing • 66% male • 74% 20-39 years of age • 58% heterosexual, 31% MSM • Laboratory results • 181 (0.69%) reactive by POC • Of 161 POC reactive tests sent for confirmatory testing, 141 (88%) confirmed HIV-positive

15. Summary, 2012 (continued) • POC test performance • 4 POC non-reactive samples were confirmed HIV-positive • HIV positivity rates • 0.55% overall • Highest for: • Men (0.76%) compared to women (0.20%) • Peaked in men at 40-49 years, whereas for women, HIV increased with increasing age • IDU (1.5%) followed by MSM (1.3%) and HIV-endemic (1.2%)

16. Conclusions • POC testing positivity rate is higher than standard testing, mainly due to a higher proportion of anonymous testing • Test specificity improved over time • The point-of-care program continues to attract high risk populations • Important to expand and target high risk populations; estimated ~9,000 undiagnosed HIV-positive people in Ontario (2009) • >99% of patients tested received a negative result immediately, alleviating the anxiety of waiting for a result and thus making the test more acceptable and accessible

17. Acknowledgements • Staff at point-of-care sites who carry out point-of-care tests and complete the HIV requisitions • Personnel, Public Health Laboratory – Toronto, Public Health Ontario • Public Health Agency of Canada, Field Surveillance Officer Program • Carol Major and the AIDS Bureau who support POC program and provided helpful advice