site also do counseling, incorporating prevention. In December 2014, the CDC issued guidelines for the use of HIV Pre-exposure Prophylaxis (PrEP) to assist HIV-negative individuals at very high risk of HIV infection in remaining uninfected. In the simplest of terms, PrEP involves taking a single antiHIV pill once a day. With the advent of this newest form of HIV prevention, HIV test counselors now are not only able to link HIV-positive clients to HIV care, but they can also connect very high risk HIV-negative individuals to a PrEP counselor. At present, there are 17 PrEP counselors located across New Jersey. To find out where to obtain both free HIV testing and free access to PrEP counselors for your patients, call the NJ AIDS/STD Hotline at 800-624-2377. JOHN EMERSON port with testing, and preestablishing a pathway into care. The process has been consistently improved, resulting in a model that has become increasingly successful at overcoming noncompliance and procrastination, and eliminating intrinsic barriers, along the way. “For example, initially people had to return a week after testing to get a final, confirmed result— 30 percent didn’t come back,” says Dr. Martin. That moved the HIV team to tie the process more tightly together. “Now, when the results are in, and you are presumptively positive, you get linked into care within two days,” says Dr. Salaru. In other states, it can take as long as two months. The sooner people get into treatment, the less likely they are to infect others as well. Rapid HIV testing is very simple and is based on evidencebased research for maximum effectiveness. “It’s a finger stick,” says Dr. Martin. Blood is collected into a loop and then goes into a device. About 20 minutes later, there’s a result. If that initial test proves positive, a second rapid HIV screen is done using a different manufacturer’s rapid immunoassay test. If HIV antibodies are confirmed in the second rapid test, then the person is considered “presumptive positive” and is linked immediately into care. Testers at the The Future he program’s goals for 2020 are ambitious. They include increasing the number of people who know their HIV status to 90 percent, increasing the number of new diagnoses by at least 25 percent, increasing the linkage to HIV care within one month to 85 percent, retaining the number of people in HIV care to at least 90 percent, and increasing the number of people who are virally suppressed to at least 80 percent. Are they achievable? “This is going to be a challenge to deal with the back end of the care continuum,” says Dr. Martin. Getting people into care is one thing. Holding them there for the long run is another. “If you go off the care continuum, you allow your viral load to go up, posing a risk of transmission. It’s a challenge point,” he says. Turning the tide is not just a global effort but a local one as well. Having the tools to identify the earliest stages of HIV infection is the first line of defense. It’s one that Robert Wood Johnson Medical School, the New Jersey Department of Health, and two professors of pathology and laboratory medicine are taking on with persistence and passion that can ultimately save lives. M Robert Wood Johnson I MEDICINE 15 t