Evaluation of Rapid Testing Algorithms for Venue-based Anonymous HIV Testing among Non-HIV-Positive Men Who Have Sex with Men, National HIV Behavioral Surveillance (NHBS), 2017
Authors: Whitby Shamaya , Smith Amanda , Rossetti Rebecca , Chapin-Bardales Johanna , Martin Amy , Wejnert Cyprian , Masciotra Silvina ,   for the NHBS Study Group, Wortley Pascale , Todd Jeff , Melton David , Klevens Monina , Doherty Rose , O’Cleirigh Conall , Schuette Stephanie Masiello , Jimenez Antonio D. , Poe Jonathon , Vaaler Margaret , Deng Jie , Al-Tayyib Alia , Mattson Melanie , Griffin Vivian , Higgins Emily , Brandt Mary-Grace , Khuwaja Salma , Lopez Zaida , Padgett Paige , Sey Ekow Kwa , Ma Yingbo , Spencer Emma , Nixon Willie , Forrest David , Anderson Bridget , Tate Ashley , Abrego Meaghan , Robinson William T. , Barak Narquis , Beckford Jeremy M. , Braunstein Sarah , Rivera Alexis , Carrillo Sidney , Bolden Barbara , Wogayehu Afework , Godette Henry , Brady Kathleen A. , Nnumolu Chrysanthus , Shinefeld Jennifer , Schafer Sean , Orellana E. Roberto , Bhattari Amisha , Raymond H. Fisher , Ick Theresa , De León Sandra Miranda , Rolón-Colón Yadira , Jaenicke Tom , Glick Sara , Buyu Celestine , Reid Toyah , Diepstra Karen , Adams Monica , Brune Christine Agnew , An Qian , Balaji Alexandra , Broz Dita , Burnett Janet , Chapin-Bardales Johanna , Cribbin Melissa , Chen YenTyng , Denning Paul , Doyle Katherine , Finlayson Teresa , Handanagic Senad , Hoots Brooke , Ivy Wade , Lee Kathryn , Lewis Rashunda , Olansky Evelyn , Paz-Bailey Gabriela , Robbins Taylor , Sionean Catlainn , Smith Amanda , Wejnert Cyprian , Xia Mingjing 
Published: July 2020

HIV rapid testing algorithms (RTAs) using any two orthogonal rapid tests (RTs) allow for on-site confirmation of infection. RTs vary in performance characteristics therefore the selection of RTs in an algorithm may affect identification of infection, particularly if acute. National HIV Behavioral Surveillance (NHBS) assessed RTAs among men who have sex with men recruited using anonymous venue-based sampling. Different algorithms were evaluated among participants who self-reported never having received a positive HIV test result prior to the interview. NHBS project areas performed sequential or parallel RTs using whole blood. Participants with at least one reactive RT were offered anonymous linkage to care and provided a dried blood spot (DBS) for testing at CDC. Discordant results (RT-1 reactive/RT-2 non-reactive) were tested at CDC with lab protocols modified for DBS. DBS were also tested for HIV-1 RNA (VL) and antiretroviral (ARV) drug levels. Of 6500 RTAs, 238 were RT-1 reactive; of those, 97.1% (231/238) had concordant results (RT-1/RT-2 reactive) and 2.9% (7/238) had discordant results. Five DBS associated with discordant results were available for confirmation at CDC. Four had non-reactive confirmatory test results that implied RT-1 false reactivity; one had ambiguous confirmatory test results which was non-reactive in further testing. Regardless of order and type of RT used, RTAs demonstrated high concordant results in the population surveyed. Additional laboratory testing on DBS following discordant results confirmed no infection. Implementing RTAs in the context of anonymous venue-based HIV testing could be an option when laboratory follow-up is not practicable.