Offering rapid point-of-care tests would increase uptake of HIV testing

Over half the people who decline to take an HIV test would do so if they had the option to take a test that gave the result in 20 minutes, report researchers in the August 2008 issue of the International Journal of STD and AIDS. The authors recommend that rapid point-of-care tests should be made routinely available in all genitourinary medicine (GUM) clinics.

UK testing guidelines recommend that all attendees at sexual health clinics are offered an HIV test, but around a quarter of attendees decline to take the test. Moreover, there is evidence that people with undiagnosed HIV infection are more likely to decline to be tested than other people.

Using standard “fourth generation” tests, most clinics make test results available within a few days or a week. There is speculation that this delay may discourage people from taking the test.

An alternative may be to use rapid point-of-care tests which take a blood sample from a fingerprick or take a saliva sample, and give results within minutes. However the disadvantage of rapid tests is the high rate of false positive results - in other words, people who do not have HIV receiving an apparent HIV positive result. For this reason, all positive results must be confirmed with standard tests.

In order to assess whether offering rapid tests would increase uptake, Sophie Forsyth and colleagues asked 899 attendees at London GUM clinics to complete a questionnaire. The study was conducted at the Mortimer Market Centre and the Archway Sexual Health Clinic. Attendees who had already received an HIV-positive diagnosis were excluded.

Participants included 465 gay or bisexual men, 4 intravenous drug users, 39 people born in a high-prevalence country and 90 sexual partners of people from high-prevalence countries. The researchers grouped them together as “high-risk patients”, in contrast to 301 low-risk patients who did not belong to any of these risk groups.

Uptake of HIV testing was 77% among the high-risk patients, and 66% for the low-risk patients.

The 137 high-risk patients who turned down the offer of an HIV test were asked if they would have agreed to be tested if a rapid test were available, and 76 (56%) said that they would. When asked about types of test, more preferred a fingerprick test to a saliva swab.

The study relies on a questionnaire presenting a hypothetical situation, rather than a real offer. However, if all of those patients did take the test, the clinics would see a 12% increase in uptake of HIV testing among high-risk patients.

Those who did not test were also asked why not. Both for high-risk and low-risk patients, the most common reasons were “I feel I am at low risk for HIV” and “I had a negative result within the last 12 months”.

However some other reasons were important for high-risk patients, but not for those in the low-risk group. In the high-risk group, 22% said they were “too scared of the result” and 10% said “I do not want to know if I have HIV”, whereas only 2% and 4% of low-risk patients gave these responses.

Moreover, whilst 15% of high-risk patients did not test because “I cannot get the result today”, this was only the case for 1% of low-risk patients who did not test.

Concluding, the authors note that rapid tests are cheaper than conventional tests, which compensates for the additional staff time needed to perform the test and explain its limitations. They believe that the use of rapid tests with high-risk groups is likely to be cost-effective, and will contribute to reductions in undiagnosed infection. They recommend that rapid point-of-care tests “should be available for routine use in all GU medicine clinics.”