Home collection for frequent HIV testing: acceptability of oral fluids, dried blood spots and telephone results

Spielberg, Freya; Critchlow, Cathy W.; Vittinghoff, Eric; Coletti, AS; Sheppard, Haynes W.; Mayer, K.; Metzgerg, D; Fn, Judson; Buchbinder, Susan; Chesney, Margaret A.; Gross, Michael L.

doi:10.1097/00002030-200008180-00018

Cited by 66 publications

(85 citation statements)

References 15 publications

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“…17,18,21 Of the 272 blood samples, 260 (96%) were suitable for serological analysis, so this diagnostic method proved logistically feasible in primary care, as has previously been described for a variety of infectious diseases, including measles, toxoplasmosis, hepatitis C, and human immunodefi ciency virus infection. 16,[22][23][24] Although our study shows that the value of dried blood spot for serological verifi cation of herpes zoster is limited, the logistic advantages of this method, such as ease of collection, transport, and storage, are evident.Some potential limitations of this study need to be addressed to appreciate the results. First, our aim was to quantify the extent to which a clinical diagnosis of herpes zoster made by the family physician could be confi rmed serologically.…”

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confidence: 99%

Clinical Diagnosis of Herpes Zoster in Family Practice

Opstelten

Loon²,

Schuller³

et al. 2007

The Annals of Family Medicine

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PURPOSE Family physicians usually diagnose herpes zoster on clinical grounds only, possibly resulting in false-positive diagnoses and unnecessary treatment. We wanted to determine the positive predictive value of the physicians' judgment in diagnosing herpes zoster and to assess the applicability of dried blood spot analysis for diagnosis of herpes zoster in family practice.METHODS Our study population consisted of 272 patients older than 50 years with herpes zoster (rash for less than 7 days). Dried blood spot samples were collected from all patients and sent by mail to the laboratory. Baseline measurements included clinical signs (localization, severity, and duration of rash) and symptoms (duration and severity of pain). Varicella-zoster virus antibodies were determined at baseline and 5 to 10 days later. Multivariate logistic regression was used to assess independent associations between clinical variables and serological confi rmation of herpes zoster.RESULTS Dried blood spot analysis was possible in 260 patients (96%). In 236 the diagnosis of herpes zoster was confi rmed serologically (positive predictive value of clinical judgment 90.8%; 95% confi dence interval, 87.3%-94.3%). Independent clinical variables for serologically confi rmed herpes zoster were severity and duration of rash at fi rst examination.CONCLUSION Family physicians have good clinical judgment when diagnosing herpes zoster in older patients. Dried blood spot analysis is a logistically convenient method for serological investigation of patients in family practice, but it is rarely needed for diagnosing herpes zoster. INTRODUCTIONH erpes zoster is a common disease, with a reported incidence varying from 2.2 to 4.8 per 1,000 persons per year. [1][2][3] It is due to a localized recrudescence of the varicella-zoster virus in sensory ganglia, where the virus has remained dormant since the primary infection (chickenpox). Age and immunity-attenuating diseases are well-known risk factors for herpes zoster. 4 The most frequent complications of herpes zoster include postherpetic neuralgia and, in cases of ophthalmic herpes zoster, sight-threatening eye problems.Because the typical unilateral rash helps family physicians diagnose herpes zoster clinically, suspected cases of herpes zoster are rarely investigated serologically or virologically. False-positive diagnosis of herpes zoster, however, is reported to occur in up to 13% of patients 5,6 and may result in unnecessary prescription of antiviral medications, erroneous referral, and unnecessary invasive interventions for the prevention of postherpetic neuralgia. 7 Serological analysis is one method to confi rm the diagnosis of herpes zoster, 8 but few studies have assessed its value in family practice. Moreover, such analysis in primary care can be fraught with logistic problems. In remote areas laboratory facilities may not be accessed easily, and for research purposes uniform analysis techniques at a central location may 306CLINIC A L DIAGNOSIS OF HER PES ZOS T ER be preferred over analy...

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confidence: 99%

Clinical Diagnosis of Herpes Zoster in Family Practice

Opstelten

Loon²,

Schuller³

et al. 2007

The Annals of Family Medicine

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“…6,7 Similar studies have been done to look at the HIV testing preferences of adults. [8][9][10][11][12] Most participants in these studies preferred rapid testing, followed by testing using oral fluid or urine. Throughout all of the studies, the least preferred method was standard blood testing.…”

Section: Discussionmentioning

confidence: 99%

Alternative HIV Testing Methods Among Populations at High Risk for HIV Infection

Greensides

Berkelman

Lansky

et al. 2003

Public Health Reports

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SYNOPSISObjective. The purpose of this study was to determine the levels of awareness and use of alternative HIV tests (home collection kit, oral mucosal transudate collection kit, and rapid tests) among people at high risk for HIV infection. Results. The overall awareness and use of the alternative tests was limited: 54% of respondents were aware of the home collection kit, 42% were aware of the oral mucosal transudate collection kit test, and 13% were aware of rapid tests. Among those aware of alternative tests, self-reported use of the tests was also low. The most common reasons given for not using alternative HIV tests were: preference for the standard test; concern that the results could be less accurate; and that alternative tests were not offered.Conclusions. The low levels of awareness and use of alternative HIV tests suggest that the potential for promoting testing among individuals at high risk for HIV by encouraging use of alternative HIV tests has not been fully realized.

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“…Furthermore, many individuals do not want faceto-face counseling (91). In a recent study, 95% of highrisk individuals opted for telephone rather than face-toface counseling when given a choice (92). Evidence suggests that HIV test counselors may be more concerned about the dangers of telephone posttest counseling then their clients, and may underestimate the ability of clients to implement home testing (92).…”

Section: Implement New Testing Technologies and Delivery Modalitiesmentioning

confidence: 99%

“…The convenience of oral testing also may facilitate bringing testing to high-risk populations (e.g., in gay bars [97]). Oral testing is also preferred to dried blood spot tests among persons using home test kits (92).…”

Section: Implement New Testing Technologies and Delivery Modalitiesmentioning

confidence: 99%

“…Rapid in-home testing might further increase the numbers of individuals who know their HIV status during the early stages of infection (102). Although public health officials would not be informed of the person's disease status, it is likely, based on other studies, that individuals would both decrease risk acts and seek care (92,103).…”

Section: Increase Access To Client-controlled Testingmentioning

confidence: 99%

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Effective Detection of HIV

Newman

Etzel

2000

Journal of Acquired Immune Deficiency Syndromes

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Summary: Biomedical advances, new HIV testing technologies, and policy shifts in the last 15 years have created substantial new challenges and opportunities for service providers, policy makers, and researchers regarding broad scale identification of HIVseropositive persons. Effective HIV testing will be achieved when we: (1) increase the number of high-risk persons tested; (2) decrease the time from HIV infection to detection; (3) increase testing acceptability; (4) increase the proportion of individuals tested who receive their results; and (5) increase the proportion of individuals tested seropositive who are linked to care. Strategies to enhance effectiveness include implementing new testing technologies and delivery modalities; expanding access to clientcontrolled testing; targeting providers' knowledge, attitudes, and behaviors regarding HIV testing; mainstreaming HIV testing as routine clinical care; targeting persons who engage in high-risk behaviors and those in high-risk groups; and implementing a national behavioral surveillance system. Addressing these challenges will improve HIV detection in the United States, which is vital to both HIV prevention and treatment.

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Home collection for frequent HIV testing: acceptability of oral fluids, dried blood spots and telephone results

Cited by 66 publications

References 15 publications

Clinical Diagnosis of Herpes Zoster in Family Practice

Clinical Diagnosis of Herpes Zoster in Family Practice

Alternative HIV Testing Methods Among Populations at High Risk for HIV Infection

Effective Detection of HIV

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