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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.

Author information

1
Institute for Microbiology, Charité - University Medicine Berlin, Berlin, Germany.
2
Department of Microbiology and Hospital Hygiene, Bundeswehr Hospital Hamburg, Hamburg, Germany.
3
Institute for Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
4
Institute for Hygiene and Environment, City of Hamburg, Hamburg, Germany.
5
Institute for Experimental Gene Therapy and Cancer Research, University Medicine Rostock, Rostock, Germany.
6
Duy Tan University, Đà Nີng, Vietnam.
7
Institute for Tropical Medicine, Eberhard Karls University, Tübingen, Germany.
8
Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine Hamburg, Hamburg, Germany.
9
Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Rostock, Germany.

Abstract

Introduction:

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.

Methods:

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.

Results:

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.

KEYWORDS:

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

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