AIDS Prevention: North Carolina HIV/AIDS Screening Method Could Become National Model

A new, first-of-its-kind effort launched by the North Carolina Department of Health and Human Services may become a model for cutting HIV transmission and saving lives across the nation. Designed and tested by University of North Carolina-Chapel Hill medical scientists and state public health officials at HHS, the Screening and Tracing Active Transmission (STAT) program began in November, its developers said.

"When used to enhance testing, the procedures are proving to be a distinct improvement over standard antibody tests. This is because antibody assays cannot detect the virus up to 2 months postinfection and therefore miss the earliest, most infectious period when carriers can spread the virus before they even know they have it," said Dr. Christopher Pilcher, chief program developer.

In the program's first 6 months, the very recent HIV infections identified in North Carolina's health departments and public testing sites have resulted in a 4 percent increase in the total number of new HIV diagnoses made in the state, Pilcher said. Overall, 17 cases of acute HIV have been identified by the STAT program, and the majority have been successfully entered into care.

Under the STAT program, patients asking for an HIV test will still receive the standard antibody test, but the specimens will also be tested individually using the polymerase chain reaction test. "So far, we have tested 50,000 patients, and the most important thing we have observed is that a significant number of very contagious infections are right now being missed by routine antibody testing," Pilcher said.

Costs associated with the added testing are low -- about $2 per test, or a little over $4,000 for each new case diagnosed -- figures that pale by comparison with the financial and human burden of missing a case or missing the opportunity to prevent further HIV transmission. An additional feature of the program is a rapid response team of about a dozen public health specialists deployed across North Carolina and responsible for contacting, counseling and getting patients into care and prevention services.

A pilot study, "Real-Time, Universal Screening for Acute HIV Infection in a Routine HIV Counseling and Testing Population," demonstrating the approach's preliminary success and promise appeared in the Journal of the American Medical Association (2002;288:216-221).

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