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HIV Counseling and Testing

HIV Counseling and Testing. Thomas J. Coates, PhD Michael and Sue Steinberg Professor of Global AIDS Research Director, UCLA Center for World Health. Varieties of Community HCT Modalities. Facility-based Mobile House-to-house Index Self-testing Workplace School Church.

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HIV Counseling and Testing

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  1. HIV Counseling and Testing Thomas J. Coates, PhD Michael and Sue Steinberg Professor of Global AIDS Research Director, UCLA Center for World Health

  2. Varieties of Community HCT Modalities Facility-based Mobile House-to-house Index Self-testing Workplace School Church

  3. VCT: Historical Perspectives: 1985 Antibody tests licensed (protect the blood supply) Anonymous testing the norm Had to include pre- and post-test counseling Strong testing campaigns in the US Not so much in Europe

  4. VCT: Historical Perspectives: 1985 $70m allocated for AIDS research Ryan White refused entry to middle school Rock Hudson dies at UCLA First AIDS conference in Atlanta hosted by WHO and CDC

  5. VCT: Historical Perspectives: 1986 Reagan says “AIDS” for the first time and vows to make AIDS a priority (thank you Elizabeth Taylor) National Minority AIDS Council formed First panel of AIDS quilt sewn HIV is named

  6. VCT: Historical Perspectives: 1987 Global Program on AIDS launched at WHO AZT approved ACT UP founded by Larry Kramer First National Conference on HIV and Communities of Color in New York First candidate vaccine tested

  7. VCT: Historical Perspectives: 1987 CDC testing guidelines released Ray house burned in Florida Western Blot test approved Liberace dies of AIDS

  8. VCT: Historical Perspectives: 1988 Helms Amendment passes; Presidential AIDS Commission formed

  9. VCT: Historical Perspectives: 1989 Precursor to the Ryan White Care Act funded by Congress 100,000 reported AIDS cases in the US

  10. VCT: Historical Perspectives: 1990 Ryan White dies Ryan White Care Act passed by Congress HIV prevention counseling model adopted by the CDC--client-centered approach

  11. VCT: Historical Perspectives: 1991 HOPWA enacted CDC recommends restrictions on HIV+ health care workers First National Skills Building Conference hosted by NAPWA Magic Johnson announces that he has AIDS

  12. VCT: Historical Perspectives: 1992 8th International Conference on AIDS moved from Boston to Amsterdam AIDS is the #1 cause of death for men 25-44

  13. VCT: Historical Perspectives: 1992 8th International Conference on AIDS moved from Boston to Amsterdam AIDS is the #1 cause of death for men 25-44

  14. VCT: Historical Perspectives: 1993 President Clinton establishes the Office of National AIDS Policy at The White House CDC establishes the community planning process to better target local prevention efforts Philadelphia released Angels in America receives the Tony Case definition of AIDS expanded (<200 CD4)

  15. VCT: Historical Perspectives: 1994 AIDS is the leading cause of death for all Americans 25-44 Randy Shilts and Peter Zamora die AZT recommended for pregnant HIV+ women to prevent mother-to-child transmission of HIV NIH addresses the appropriate inclusion of women and minorities in HIV clinical research

  16. VCT: Historical Perspectives: 1995 Greg Louganis discloses that he has HIV Eric Lynn Wright (Eazy-E) dies one month after being diagnosed with HIV 500,000 cases of AIDS reported in the US First White House Conference on AIDS convened

  17. VCT: Historical Perspectives: 1996 HAART unveiled at Vancouver AIDS Conference Number of reported AIDS cases declines for the first time in the US UNAIDS formed AIDS Memorial Quilt covers the entire Mall in DC Ryan White Care Act reauthorized

  18. VCT: Historical Perspectives: 1997 AIDS deaths decline Combination therapy approved by FDA UNAIDS estimates 30m people with HIV worldwide Clinton establishes goal of HIV vaccine in 10 years

  19. VCT: Historical Perspectives: 1998 African-Americans account for 49% of AIDS-related deaths; AIDS related mortality 10x that of whites and 3x that of Latinos Clinton announces a special package of initiatives aimed at HIV in minority communities; Minority AIDS Initiative passed by Congress with $156m Shalala announces that needle exchange programs are effective The Supremes say that the ADA covers people with HIV

  20. VCT: Historical Perspectives: 1999 WHO announces that AIDS is the 4th biggest killer worldwide; 33m infected; 16m have died VaxGen vaccine trial starts in Thailand Clinton announces new global initiative for HIV

  21. VCT: Historical Perspectives: 2000 United Nations Security Council discusses AIDS as a global security issue (#1 for any health issue) Durban AIDS Conference Clinton announces Executive Order to permit developing countries to import generic drugs Global AIDS and Relief Act of 2000 Ryan White Care Act reauthorized We announce the results of our study of HCT

  22. VCT: Historical Perspectives: 2001 UN Secretary Kofi Annan calls for the global AIDS fund “war chest” US Secretary of State Colin Powell reaffirms that HIV/AIDS is a national security threat First Annual National Black AIDS Awareness Day in the US World Trade Organization announces DOHA Agreement to allow developing countries to buy or manufacture generics

  23. VCT: Historical Perspectives: 2002 UNAIDS reports that women comprise about half of all adults living with HIV/AIDS worldwide HIV is leading cause of death worldwide among those aged 15-59 Approval of OraQuick rapid HIV-1 Antibody Test by FDA; first rapid test to use finger prick

  24. VCT: Historical Perspectives: 2003 3 by 5 Initiative announced by WHO South Africa announces new antiretroviral treatment programs William J. Clinton Presidential Foundation secures price reductions for HIV/AIDS drugs to benefit developing nations

  25. VCT: Historical Perspectives: 2004 Global Fund holds first Partnership Forum in Bangkok with 400 participating dleegates UNAIDS launches the Global Coalition on Women and AIDS PEPFAR, President Bush’s Emergency Plan for AIDS Relief, begins first round of funding OraQuick Rapid HIV-1 Antibody Test approved for use with oral fluid by FDA

  26. VCT: Historical Perspectives: 2005 World Economic Forum in Davos priorities include a focus on addressing HIV/AIDS in Africa First Annual National Asian and Pacific Islander HIV/AIDS Awareness Day in the United States Ranbaxy is the first Indian drug manufacturer to gain US FDA approval to produce generic antiretrovirals for PEPFAR

  27. VCT: Historical Perspectives: 2006 First Annual National HIV/AIDS Awareness Day in the US CDC recommends routine HIV in health care settings First Annual National Women and Girls HIV/AIDS Awareness Day in the US

  28. VCT: Historical Perspectives: 2007 President Bush calls on Congress to reauthorize PEPFAR at $30b over 5 years WHO and UNAIDS issue guidance recommending ‘provider initiated’ HIV testing in health care settings WHO and UNAIDS recommend that male circumcision should always be considered as part of a comprehensive HIV prevention package

  29. VCT: Historical Perspectives: 2008 US Congress reauthorizes PEPFAR for 5 years at up to $48b 17th International AIDS Conference ”Universal Action Now” in Mexico City First Annual National Gay Men’s HIV/AIDS Awareness Day in the United States CDC releases new HIV incidence estimates for the US, showing that the US epidemic is worst than thought

  30. VCT: Historical Perspectives: 2009 Newly elected President Obama calls for the first ever National HIV/AIDS Strategy The Obama Administration lifts HIV travel and immigration ban by removing regulatory barriers to entry US Congress eliminates long-standing statutory ban on the use of Federal funding for needle exchange in the US

  31. VCT: Historical Perspectives: 2010 Obama Administration releases first comprehensive HIV/AIDS strategy for the US South African investigators announce the results of CAPRISA004 showing that the use of a microbicide gel reduces risk of HIV infection by 39% iPrEx shows that the daily dose of a Truvada reduced risk of acquiring HIV among MSM by 43%

  32. VCT: Historical Perspectives: 2011 HHS launches the 12 Cities Project to focus resources on the areas with the highest AIDS burden in the country Secretary Clinton and President Obama announce the goal of an AIDS-free generation HPTN 052 demonstrates the importance of treatment as prevention Elizabeth Taylor dies

  33. VCT: Historical Perspectives: 2012 FDA approves OraQuick In-Home Test The first rapid over-the-counter rapid test that can be bought over the counter and read at home Truvada approved for PrEP

  34. Varieties of Community HCT ModalitiesAcceptance of Testing Mobile—87% House-to-house—80% Index—88% Self-testing—87% Workplace—67% School—62%

  35. Principles of HIV Counseling and Testing Screening donor blood and cellular products Diagnosis of HIV infection (sensitivity and specificity) Human rights (confidential, counseling, informed consent) Confidentiality Anonymous testing Routine testing

  36. Uptake of HCT (Suthar et al, PLoS Medicine, 2013)

  37. Community HCT Modalities Increased testing uptake—RR=10.65 (6.27-18.08) Proportion of first-time testers—RR=1.23 (1.06-1.42) Proportion of testers CD4 > 350—1.42 (1.16-1.74) Lower positivity rate—RR=0.59 (0.37-0.96)

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