Michigan participates in a CDC-funded initiative to introduce HIV incidence testing into routine surveillance nationwide called STARHS (Serologic Testing Algorithm for Recent HIV Seroconversion).  The goal of STARHS is to produce incidence rates (rates of recent infection, in the last 6 months) beyond the traditionally reported prevalence rates for HIV and AIDS.

HIV incidence data has important public health implications for evaluating HIV intervention and prevention programs for effectiveness, for targeting prevention efforts associated with ongoing transmission, and for allocating resources to populations in greatest need of prevention efforts.

STARHS estimates HIV incidence rates based on the results of an incidence test (BED Assay) and a few testing and treatment history questions answered by the infected person.  Testing and treatment history information is needed to help make population based estimates of incidence.

The STARHS incidence test is performed automatically on leftover serum from the diagnostic, confirmed-positive specimen.  The remnant serum is sent to the New York State STARHS Lab for testing after the routine EIA and Western blot tests are done.  If the original diagnostic specimen is not available, a subsequent serum or plasma specimen obtained within 3 months of diagnosis is acceptable for testing.

QUICK FACTS:

• All newly reported HIV or AIDS Michigan cases over the age of 12 who tested confidentially (not-anonymous) are automatically included in the STARHS protocol
• No consent for the additional BED incidence test is required beyond the initial consent for HIV testing.  This test is part of routine surveillance.
• Only serum or plasma specimens are acceptable; no oral specimens or dried fluid spot specimens at present.
• Incidence test results are not returned to clinician or patient because the results are reliable only on a population basis, not for individuals.
• Antiretroviral therapy taken within the 6-month period before the specimen to be tested was collected will produce false "recent" results on the incidence test.
• Testing and Treatment History required:
  • Date of first positive HIV test
  • Date of last negative HIV test, or "No previous HIV testing"
  • Number of negative HIV tests in the 2 years preceding the first positive HIV test.
  • Antiretroviral medication history for the rare tester who has been treated (usually for post-exposure prophylaxis, pre-exposure prophylaxis, or medications for Hepatitis B that overlap with HIV, e.g. Epivir).  Names of medications and dates started and ended needed.  

QUICK LINKS:

One page summary of STARHS for providers (PDF)

Testing and treatment history questionnaire to be completed by a client/patient (PDF)

Testing and treatment history questionnaire to be completed by a client/patient in Spanish (PDF)

Testing and treatment history questionnaire to be completed by staff (PDF)

Antiretroviral medication chart (for reference in answering medication questions) (PDF)

For more information on STARHS, please contact:  Marianne O'Connor, MPH, MT (ASCP) , 313-876-0854

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