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Eur J Microbiol Immunol (Bp). 2018 May 5;8(2):47-52. doi: 10.1556/1886.2018.00007. eCollection 2018 Jun 25.

Diagnostics as Prevention - A Rapid Testing-Based Strategy of Sex Workers against Sexual HIV Exposure.

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Institute for Microbiology, Charité - University Medicine Berlin, Berlin, Germany.
Department of Microbiology and Hospital Hygiene, Bundeswehr Hospital Hamburg, Hamburg, Germany.
Institute for Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Institute for Hygiene and Environment, City of Hamburg, Hamburg, Germany.
Institute for Experimental Gene Therapy and Cancer Research, University Medicine Rostock, Rostock, Germany.
Duy Tan University, Đà Nີng, Vietnam.
Institute for Tropical Medicine, Eberhard Karls University, Tübingen, Germany.
Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine Hamburg, Hamburg, Germany.
Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Rostock, Germany.



German sex workers have illegally established a prevention strategy, which consists of testing potential sexual partners with human immunodeficiency virus (HIV)-specific rapid diagnostic tests (RDTs) prior to engaging in unprotected sexual intercourse eventually performed in case of a negative test result. Based on a recently established modeling approach, the effectiveness of this strategy regarding the risk of HIV exposure was compared with protection provided by condom use.


Based on a literature search, the following assumptions were used for the calculations: an averaged 80% exposure risk reduction with a condom used during sexual intercourse, usage of a well-characterized 4th-generation HIV RDT, and a 10 day post-infection period without any measurable viral load in peripheral blood followed by a sero-conversion period of about 3 weeks with 12.3% test sensitivity (antigen-specific) and only afterwards 97.3% (antibody-specific) test sensitivity.


In most constellations, the HIV exposure risk in case of RDT-based prevention was lower than with condom use. Conclusions: The RDT-based HIV exposure prevention as established by sex workers is effective in most situations. A notable weakness of the strategy is the RDTs' poor sensitivity in spite of a high transmission risk during the seroconversion stage.


HIV; exposure risk; prevention; rapid testing; risk assessment; sex worker

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