Berry Bennett MPH, Retrovirology Chief, Florida Bureau of Laboratories
Sally Fordan BS, Retrovirology Supr., Florida Bureau of Laboratories
Background: In August 2003, the Florida Bureau of HIV/AIDS initiated several pilot sites throughout the state to evaluate the feasibility and acceptance of POC HIV rapid testing. The Florida Bureau of Laboratories was enlisted to perform confirmatory laboratory-based testing on POC presumptive positive cases using the CDC recommended algorithm.
Issues:
1) The state program office desired an expedited laboratory confirmation and reporting process because of the transient nature and/or the temporary housing (county jails, etc) of the projected clients to be offered POC rapid testing.

2) The laboratory needed to modify its traditional testing algorithm to follow CDC’s guidelines for these select presumptive positive cases as well as revise its data entry and reporting processes.

3) The laboratory would be responsible for developing additional in-house algorithms to resolve discordant cases and provide specimens to CDC upon request.
Lessons Learned/Recommendations:
Cooperation between the state program office and the state laboratory produced a new HIV requisition form to allow easy identification of presumptive positive rapid tests upon arrival at the laboratory. This allows the laboratory to expedite data entry, testing and reporting. Clear identification of presumptive positives will hopefully avoid delayed and incomplete confirmation testing.

As discordant cases were detected, the laboratory identified the need to repeat the initial rapid tests in-house, test with other rapid assays, perform molecular testing and enlist CDC to resolve.

Any presumptive positive is a potential discordant case. It was quickly determined that the desired confirmation sample should be a serum or plasma as opposed to an oral fluid specimen to allow broader infectious disease testing, if applicable, at both the state laboratory and CDC. Unfortunately, some of the pilot sites are not able to perform phlebotomy.

Last Update: April 8, 2005