National HIV Testing Day, June 27

National HIV Testing Day is observed on June 27 of each year to raise public awareness of the importance of knowing one’s HIV status and to encourage communities, organizations and governments to support HIV testing initiatives. APHL salutes the governmental laboratories that diagnose hard-to-identify HIV infections. The service provided by these public health laboratories protects the health of individuals and the community at large.

Even with the enormous advances over the past several years, traditional HIV tests may not identify individuals in the early stages of HIV infection or who are infected with HIV-2, a less common and slower progressing strain of HIV. Although new laboratory-based methods promise to detect more early infections, detection and diagnosis of HIV-2 remains a concern.

According to Dr. Mike Pentella, associate director of the State Hygienic Laboratory at the University of Iowa, “We have identified two HIV-2 infections in recent years that may have been missed if thorough laboratory testing was not conducted. Public health laboratories, through their ability to identify difficult infections like HIV-2 and acute HIV-1 infections, make a significant contribution to HIV prevention efforts.” Dr. Pentella also serves as the chair of the APHL/CDC HIV Steering Committee.

There currently is no FDA-approved confirmatory test for HIV-2.

“You need an accurate and reliable diagnosis before you can treat someone,” says Dr. Patrick Luedtke, president of APHL’s board of directors and director of the Unified State Laboratory in Utah. “While it is obviously critical to use a reliable testing method for the purposes of patient diagnosis, it is also crucial for monitoring its spread."

APHL commends our members, colleagues and partners who work every day to improve outreach and provide accurate and timely diagnostic testing for the public health community.

Approaches to Combating HIV/AIDS

At a recent amFAR (The Foundation for AIDS Research) sponsored Congressional briefing* on AIDS research at NIH, Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Disease (NIAID), described what he viewed as the three essential approaches in combating HIV/AIDS: 

• controlling disease progression
• preventing new infections; and
• curing existing infections.

Antiretroviral therapy (ARV) is one of the most potent interventions available in medicine today and can significantly prolong a patient’s life. Continued expansion of ARV therapy, especially in the developing world, is essential to controlling disease progression and improving patient outcomes.

 

For a sustainable response to the pandemic, however, preventing new infections will be crucial. A significant focus of NIH funding supports vaccine development and treatment research (Pre-Exposure Prophylaxis, test & treat programs, and microbicides). Dr. Fauci cited the positive results of a vaccine trial last year as a significant first step towards developing an effective vaccine.

 

In the coming years, NIAID plans to continue investing in vaccine research to build on this preliminary success. The ability to cure existing infections would be an incredible breakthrough, but as Dr. Fauci mentioned, HIV is capable of hiding in the body making a true sterilizing cure very difficult to develop. Research is continuing, though, especially on so-called “functional cures” that wouldn’t completely eliminate the virus from the body but would prevent its proliferation and pathogenesis without the need for additional treatments.

 

While it is clear that a great deal of research funding is directed toward HIV vaccines and cures, NIH is also committed to researching new approaches in testing and treatment. It is estimated that 21% of HIV-infected individuals are unaware of their status. In efforts to expand testing, public health laboratories will continue to play an important role in the public health response to this pandemic.

 

*The briefing was held in collaboration with the offices of Congresswoman Rosa DeLauro (D-CT), Congresswoman Barbara Lee (D-CA), and Congressman Eliot Engel (D-NY). Thank you to those offices for their support.

 

APHL Working to Ensure Power for Laboratory Services in Haiti

When the electrical grid comes back on-line in Haiti, the country’s laboratory system will be able to ramp up services quickly thanks to measures put in place before the magnitude 7.0 temblor January 12.

Even before the devastating earthquake, electrical power in Haiti was unreliable, with routine outages and serious voltage and frequency variations that compromised laboratory testing. Outages can lead to the loss of valuable testing reagents that must be stored at controlled temperatures, while “dirty power” is damaging to a wide range of laboratory equipment, including instruments used for diagnostic testing to support antiretroviral treatment for HIV-infected patients.

With funding from CDC’s Global AIDS Program and funding and technical assistance from the US Agency for International Development, APHL invested in site-specific technologies to improve the quality of the power received from the electric grid and provide continuous power during grid power outages. The core technologies include uninterruptible power supplies, generator back-up power with automatic transfer switches and no-contact inverter battery systems.

In addition, APHL has provided on-site maintenance and supervisory support visits with two-person teams comprised of one laboratory technologist and one service technician that travel to 16 supported sites throughout the country. Thankfully, Haiti’s national public health laboratory, the Laboratoire National de Santé Publique in Port-au-Prince, remains standing in the aftermath of the earthquake.

Although the massive relief effort has consumed all the country’s resources—with surviving laboratory staff understandably focusing on their homes and families—APHL is hopeful that conditions will improve enough to enable public health testing to resume in the not too distant future. At that point, the electrical support infrastructure will be a valuable help.

HIV Testing & Public Health Laboratories

According to a CDC estimate, close to 250,000 Americans are unknowingly infected with HIV. CDC recommends HIV screening as part of routine patient care for all people between the ages of 13 and 64. Yet despite improvements in care, social stigma and lack of awareness still prevent many from receiving tests for HIV.

Rapid detection of new HIV infections and successful linkage of HIV-positive patients into care are crucial factors in breaking the transmission cycle. In an effort to improve outreach and access to testing, CDC is targeting resources to high-risk communities. But while community outreach is integral part of the fight against HIV, fast and accurate laboratory diagnostics also plays an important role.

Public health laboratories support HIV treatment and prevention initiatives in multiple ways. They not only provide timely diagnostic tests, but many also conduct surveillance for drug resistance and offer tests for patient care and disease management. Public health laboratories implement advanced testing technologies as they become available to detect infections earlier and confirm infections more accurately.

The observance of National HIV Testing Day this past Saturday highlights the role of community outreach and increased testing in fighting the HIV epidemic. But behind the scenes, the daily work of public health laboratories plays an essential role in the speedy diagnosis of infection and the vigilant surveillance of disease.

2010 Proposed Federal Budget

President Obama recently unveiled his proposed 2010 federal budget. Unfortunately, it was disappointing to see that the budget generally maintained, but did not increase, the levels of funding for most governmental public health priority programs. The budget for CDC was approximately $6.6 billion, a 0.4% increase from 2009’s budget of approximately $6.3 billion.

A few key laboratory areas did, however, receive greater funding:

▪ FDA funding for food safety was increased. However, there was no sizable increase for CDC activities, most notably PulseNet. To ensure America’s food supply is protected, it’s important that all elements of the food safety infrastructure are adequately funded.
▪ There was a $51 million increase in HIV/AIDS funding, most of which was primarily for point-of-care programs and not for laboratory testing.
▪ It was the third year running that newborne screening activities received dedicated funding.

For more information about the budget, please browse the online document.