Acute Infections, Cost per Infection and Turnaround Time in Three United States Hospital Laboratories Using Fourth-Generation Antigen-Antibody Human Immunodeficiency Virus Immunoassays

Background.  

To improve clinical and public health outcomes through early human immunodeficiency virus (HIV) detection, fourth-generation antigen/antibody immunoassay (4IA) and supplemental testing results must be returned rapidly. 

Methods.  

We examined HIV testing data at Harborview Medical Center (HMC), Massachusetts General Hospital (MGH), and the Medical University of South Carolina (MUSC), which used 4IA and supplemental antibody and nucleic acid tests (NATs). At MGH and MUSC, HIV-1 Western blot (WB) and HIV-2 testing were conducted at a reference laboratory. We compared time from specimen collection to laboratory result for established (positive WB) and acute infections (reactive 4IA, negative/indeterminate WB, detectable NAT), and we calculated testing cost per positive-test result. 

Results.  

From 3731 (MUSC) to 19 774 (MGH) tests were conducted; 0.01% (MGH) to 0.05% (HMC) were acute infections. Each laboratory had reactive 4IA, WB-negative, or indeterminate specimens without NAT (ie, potential acute infections). Time to result was 1.5 (HMC) to 5.2 days (MGH) for acute and 1.0 (HMC) to 5.2 days (MGH) for established infections. Costs were $1054 (MGH) to $1521 (MUSC). 

Conclusions.  

Conducting supplemental testing in-house lowered turnaround times, which may be further reduced with rapid HIV-1/HIV-2 differentiation tests. Hospitals may benefit from quantitative NATs not requiring physician orders, so all potential acute infections receive NAT.

Below:  HIV testing algorithm used at Massachusetts General Hospital and the Medical University of South Carolina

Below:  HIV testing algorithm used by Harborview Medical Center

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By:  Wesolowski LG1, Nasrullah M1, Coombs RW2, Rosenberg E3, Ethridge SF1, Hutchinson AB1, Dragavon J4, Rychert J5, Nolte FS6, Madory JE6, Werner BG7.

• 1Division of HIV/AIDS Prevention , National Center for HIV, Hepatitis, STD & TB Prevention, Centers for Disease Control and Prevention , Atlanta, Georgia.
• 2Departments ofLaboratory Medicine; Medicine, Harborview Medical Center, Seattle, Washington.
• 3Departments ofMedicine; Pathology, Massachusetts General Hospital, Boston.
• 4Departments of Laboratory Medicine.
• 5Pathology , Massachusetts General Hospital , Boston.
• 6Department of Pathology and Laboratory Medicine , Medical University of South Carolina , Charleston.
• 7Bureau of Infectious Disease, Massachusetts Department of Public Health, Boston. 
• Open Forum Infect Dis. 2015 Dec 9;3(1):ofv188. doi: 10.1093/ofid/ofv188. eCollection 2016.

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Laboratory Diagnostics Market in East Africa: A Survey of Test Types, Test Availability, and Test Prices in Kampala, Uganda

Below:  Bar graph of tests offered in Kampala, ranked by Availability Index* and sub-categorized by laboratory affiliation.

Bar graph depicting the contribution of different sectors in the laboratory market to availability of tests in Kampala, Uganda. Each number on the Y axis corresponds to a different test (see Fig 1 or S2 Table for identification of tests).

Test volumes and menus were obtained for 95% (907/954) of laboratories in Kampala city. These 907 laboratories offered 100 different test types. The ten most commonly offered tests in decreasing order were Malaria, HCG, HIV serology, Syphilis, Typhoid, Urinalysis, Brucellosis, Stool Analysis, Glucose, and ABO/Rh. In terms of AI, the 100 tests clustered into three groups: high (12 tests), moderate (33 tests), and minimal (55 tests) availability. 50% and 36% of overall availability was provided through private and public laboratories, respectively. Point-of-care laboratories contributed 35% to the AI of high availability tests, but only 6% to the AI of the other tests. The mean price of the most commonly offered test types was $2.62 (range $1.83–$3.46).

One hundred different laboratory test types were in use in Kampala in late 2011. Both public and private laboratories were critical to test availability. The tests offered in point-of-care laboratories tended to be the most available tests. Prices of the most common tests ranged from $1.83-$3.46.

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