Program's experience with using rapid HIV test proves mostly positive
January 1, 2007
Program's experience with using rapid HIV test proves mostly positive
State won award for program
Three years of experience using the rapid HIV test have shown New Jersey public health officials that using the rapid test is preferred by clients, and the results are reliable, a recent study shows.
"We started rapid testing on Nov. 1, 2003, at publicly-funded sites," says Evan M. Cadoff, MD, professor of pathology at the Robert Wood Johnson Medical School of New Brunswick, NJ. Cadoff also is the laboratory director for most of the HIV testing and counseling sites in New Jersey. New Jersey's rapid testing program received the 2006 Vision Award from the Association of State and Territorial Health Officials.
Approximately 30,000 to 40,000 HIV tests are conducted each year. The switch to rapid testing evolved on a site-by-site basis rather than all at one time, Cadoff notes.
"The counseling for the rapid test is a little bit different, and staff needed to learn quality steps necessary to ensure results are reliable," Cadoff says. "It's up to the counselors whether they do a fingerstick test or oral collection."
About 60 to 70 percent of clients have the oral HIV rapid test, he adds.
"When we look at the numbers, there are slightly more false positive results with the oral test, as opposed to the fingerstick," Cadoff says. "There have been sporadic reports of significantly higher false positive rates [in other cities], but we have not seen that in our system."
Cadoff and co-investigators reviewed New Jersey's HIV data since March 2005, and found that the specificity of the fingerstick testing exceeded 99.9 percent. There was a slight increase in the false positive rate — a 99.5 percent specificity — when sites moved from blood to oral fluid testing.1
Investigators concluded that no increase in false positives occurred beyond what would be expected with the transition to oral fluid testing.1
"We looked specifically to see if there were any patterns in false positives," Cadoff says.
When comparing the New Jersey data with data from cities that saw a spike in false positives, investigators looked at testing techniques, including how the specimen is collected, how devices are stored, whether temperatures are outside specifications, and other details, he says.
They concluded that the accuracy of New Jersey's rapid HIV testing program was due to its organization and attention to those details.
Since implementing the rapid test, the testing volume has increased, Cadoff says.
Initially, it appeared that the rate of HIV positive tests increased, but that didn't hold up over time, he notes.
"Perhaps it didn't hold up because more people who are not at risk for HIV are coming in for the test now, and that dilutes the effect," Cadoff says.
As more sites debate switching to the rapid test, it's important to keep in mind that risk reduction counseling can have a greater impact when clients have the test result in front of them, Cadoff says.
Prior to implementing rapid testing, the state lost contact with 35 percent of those tested, who did not return for their results, he says.
"Now 99 percent of people tested are getting their results and getting the prevention message," Cadoff says. "Anyone who has a positive finding needs to have a second test done, but we can start the process of getting them set up for treatment somewhere, and this has made the referral process easier."
Sometimes, a referral is as simple as taking the person down the hall, he notes.
Due to the Center for Disease Control and Prevention's new guidelines on testing and counseling, testing sites no longer need to provide as extensive counseling prior to conducting the HIV test, but counseling remains an important part of the process, Cadoff says.
"The worst thing that could happen here is to have a counseling message be that you don't have to be as vigilant in preventing infection," Cadoff says.
With the program's established success, the state now is trying to get rapid testing done in more emergency departments, Cadoff notes.
"There was a pilot study done in New Jersey a number of years ago that looked at the prevalence of positivity among patients in emergency rooms, and it was significantly higher than at counseling and testing sites," Cadoff says.
So far, more than 10 emergency departments are involved in the program.
"The state would like to have the program be part of the ER visit and not something the state has to fund," Cadoff says. "But since it's still counseling and testing, it falls somewhere in the middle and is largely done so it doesn't cost the hospitals anything."
Reference:
- Cadoff EM, et al. NJHIV's rapid testing program keeps false positives in check. Presented at the IDSA annual conference, held Oct. 12-15, 2006, in Toronto, ON. Abstract: 921.
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