Optimizing the Approach to HIV Testing

Voluntary counseling and testing for HIV infection using an enzyme immunoassay (EIA) with confirmatory Western blot (WB) testing has been the standard of care in most sexually transmitted infection (STI) clinics. To enhance HIV surveillance, public health officials implemented an augmented testing strategy from 2004 through 2006 at San Francisco's lone publically funded STI clinic, adding a less-sensitive EIA test to distinguish recent from chronic infection, pooled nucleic-acid amplification testing of antibody-negative samples to identify acute HIV infection, and genotypic HIV resistance testing for all individuals with newly diagnosed HIV infection.

During the 3-year period, 9868 consecutive patients were tested using the enhanced surveil…