Will Patients “Opt In” to Perform Their Own Rapid HIV Test in the Emergency Department?

Abstract

Objective To evaluate the feasibility and accuracy of existing point-of-care (POC) HIV tests performed by an untrained patient compared to the routinely used HIV POC test offered to patients in two urban emergency departments (ED). Methods From April 2008 through December 2009, patients, who had completed a standard HIV oral fluid test performed by a trained healthcare professional and who were unaware of their results, were recruited to perform a rapid POC HIV test. Patients were given a choice of the oral fluid or the finger-stick blood POC. Evaluation of acceptability to perform the mechanics of the test was accessed by questionnaire. For the “self-test,” the participant obtained his/her own sample and performed the test. The patient’s results were compared to standard oral fluid results obtained by the health care professional. Results Overall, 478 of 564 (85%) patients receiving a standard oral fluid HIV test volunteered, with a mean age of 38–39 years. Ninety-one percent of participants chose oral fluid and 9% chose blood (p<0.05). Self-test results were 99.6% concordant with health care professionals’ test results. For the self-testers, 94% of oral fluid testers and 84.4% of blood testers reported trusting the self-administered test result “very much.” Furthermore, 95.6% of oral fluid group and 93.3% of the blood group would “probably” or “definitely” perform a test at home, if available. Conclusions This study demonstrated that a significant proportion of patients offered a self-HIV POC volunteered and preferred using oral fluid. Patients’ results agreed with standard HIV POC results. The majority of participants trusted their results and would perform a POC HIV test at home, given the opportunity.

What Should the Ideal HIV Self-Test Look Like? A Usability Study of Test Prototypes in Unsupervised HIV Self-Testing in Kenya, Malawi, and South Africa

“…A review of 11 studies across different contexts suggested HIVST has high acceptability in most instances and increases the reach of HIV testing services with users capable of providing accurate results [3]. Data indicating user preference for oral or blood rapid tests are weak; however, users generally have more difficulty performing blood-based rapid tests [4,5]. In Singapore, of 350 participants using fingerstick rapid tests, almost 90 % found the kit and instructions easy to use and understand.…”

A review of Human Immunodeficiency Virus (HIV) rapid testing

“…Pant Pai (2013) (9) Overall acceptability: 74% to 96% for both supervised and unsupervised settings (7,35,(43)(44)(45)(46)(47)(48)(49) (10,54,69) Overall: 47% to 100% (all US studies) (20,54,55,65).…”

“…In 2008, the license was amended to include the INSTI™ HIV-1/HIV-2 Antibody Test (6). This test is a preliminary antibody screening test that can be performed on site where the patient can receive their results immediately (< 1hr) (7)(8)(9)(10). If the patient receives a preliminary reactive result, a confirmatory test using traditional laboratory-based testing is required.…”

HIV self-testing strategy: the middle road

“…Individuals should be able to follow clear instructions, properly collect their own samples, to accurately perform and interpret the tests [2]. Reported errors range from touching the pad of the test with fingers, to forgetting to place the test device in the developer for 20 min [7][8][9]12]. These can be reduced with clear instructions, in several different formats, languages to help reduce their occurrence [2].…”

“…Current evidence from studies suggests a high acceptability of self-testing in most at risk for HIV populations worldwide, -like healthcare workers (HCWs) [6], men who have sex with men (MSMs) [7], emergency department attendees (EDAs) and the general populations from both developed and developing settings [8,9]. Despite strong evidence of acceptability, and preferences, challenges and opportunities, self-testing presents with its share of challenges and opportunities.…”