Choice of Rapid HIV Testing and Entrance Into Care in Baltimore City Sexually Transmitted Infections Clinics

Abstract

Point-of-service (POS) HIV testing in sexually transmitted infection (STI) clinics is one public health strategy to increase knowledge of serostatus and to facilitate entry into care. Variation has been reported in clients' views of test reliability and rates of test acceptance. Our objective was to characterize STI clinic patients' choice of POS versus conventional testing (enzyme-linked immunosorbant assay [ELISA] followed by Western blot, with results in 1 week) in Baltimore, Maryland (a high-prevalence city) when both were offered (May through August 2008), then to compare rates of engaging in care. Odds ratios (OR) with 95% confidence intervals (CI) described factors associated with test type choice, as well as HIV test type with entrance into care. The overall prevalence of HIV among testers was 1.1% (60/5101). Those reporting receptive anal sex (OR 1.4; 95% CI 1.1-1.7), illicit drug use (OR 1.3; 95% CI 1.0-1.6), or an HIV-positive sexual contact (OR 1.5; 95% CI 1.0-2.2) were more likely to choose POS testing, as were those who had been tested for HIV previously (OR 1.3; 95% CI 1.1-1.5). Hispanics were less likely to choose POS testing (OR 0.6; 95% CI 0.4- 0.7). Entry into care was low in both categories of test takers (52% in POS testers versus 42% in conventional testers, p = 0.58). Patients at the highest risk for HIV preferred POS testing in STI clinics. Strengthening linkage to care is important for optimizing outcomes of HIV-positive patients presenting to STI clinics.

Performance of Determine Combo and other point-of-care HIV tests among Seattle MSM

“…The first consideration is whether there are technical or staffing limitations that prohibit the use of laboratory-based tests, or whether the population targeted for testing has low rates of follow-up. Point-of-care (POC) tests have one advantage over laboratory-based HIV tests in that more persons receive results [24, 25], although this may or may not translate into greater likelihood of linkage to care among persons testing newly HIV-positive [26, 27]. Programs should next consider whether the population being tested has a high HIV incidence and short inter-test intervals, both of which increase the likelihood of testing in the window period and decrease the clinical sensitivity of HIV antibody tests.…”

Relative accuracy of serum, whole blood, and oral fluid HIV tests among Seattle men who have sex with men

“…One advantage attributed to POC tests over laboratory-based testing is that more persons receive test results [7, 8], although this may or may not translate into greater likelihood of linkage to HIV care [9, 10]. One disadvantage of currently FDA-approved POC tests is that they have sensitivity during the “window period” comparable to the earliest generation EIAs [11-14].…”

Substance Abuse Treatment Utilizing Medication Assisted Treatment as HIV Prevention

“…Thus, strategies such as opt-out testing, home-based testing, dor-to-door testing as well as providing dedicated HIV testings counselors at point-of-service locations are being utilized to enhance the uptake of HIV testing for people who use alcohol and inject drugs. Studies have shown that most-at-risk populations prefer point-of-service HIV testing, however, this intervention requires additional measures to support HIV positive individuals entering into HIV care and treatment (Keller et al 2011). 6. Preventing HIV transmission by integration of medication assisted treatment into HIV care and treatment drug users and alcohol abusers, encounter numerous barriers in accessing HIV care and treatment.…”