Screening for acute human immunodeficiency virus infection in Baltimore public testing sites.

BACKGROUND: Human immunodeficiency virus (HIV) RNA testing of pooled HIV antibody-negative specimens can identify acute HIV infection (AHI) and trigger interventions to reduce transmission during this highly infectious period. METHODS: A Baltimore, MD program serving sexually transmitted disease clinics and other high-risk sites combined HIV testing by third-generation enzyme immunoassay (EIA) with RNA testing of pooled antibody-negative specimens. Laboratory and Disease Intervention Specialists' records were reviewed for program evaluation. A cost analysis was performed. RESULTS: In 22 months, we tested 60,695 specimens for HIV. Of these, 1766 (2.9%) tested positive by EIA. Pooled HIV RNA testing of 58,925 EIA-negative specimens detected 7 cases of AHI (0.01%). Reflex HIV RNA testing of EIA-reactive, Western blot-indeterminate specimens confirmed 4 additional AHI cases (total AHI, 0.02%). Contact tracing detected no additional previously unknown cases of HIV infection. CONCLUSIONS: The utility of pooled HIV RNA testing may be limited by advances in HIV testing technology that reduce the seronegative window period and by characteristics of the local HIV epidemic.

Gonorrhea reinfection among sexually transmitted disease clinic attendees in Baltimore, Maryland.

OBJECTIVES: We hypothesized that an active follow-up program to assess for reinfection after gonorrhea treatment could be a useful disease control strategy. GOAL: We evaluated an active follow-up and repeat testing program for all Baltimore sexually transmitted disease clinic patients diagnosed with gonorrhea. STUDY DESIGN: From September 2003 to May 2004, all clients with a treated gonorrhea infection were advised to return 3 months later for repeat testing. If clients did not return as scheduled, field outreach was attempted. At follow-up visits, urine was tested for gonorrhea and consenting participants completed a behavioral survey. In addition, we reviewed morbidity records for any intercurrent gonorrhea infections reported during the project period. RESULTS: Of the 667 participants diagnosed with gonorrhea at baseline, 54 had a gonorrhea reinfection diagnosed for an incidence of 13.8 per 100 person-years. One hundred seventy-eight (27%) either presented for a follow-up visit or were located through field efforts, and of these, 5 (2.8%) had gonorrhea detected on follow-up urine testing. No measured factors had predictive value in identifying gonorrhea reinfection. CONCLUSIONS: Although reinfection rates were high, we found that field staff intervention to increase follow-up testing rates did not identify a significant amount of repeat infections compared with passive surveillance.