At-risk groups buy home HIV blood tests
Gays, blacks, Hispanics are main customers
The three blood tests for HIV approved for home use last fall in the United States apparently are being purchased by some of the very people who need to be using them — those who are members of the groups at high risk for HIV infections.
"Basically, the tests are reaching an audience who needs them," says Bernard Branson, MD, medical epidemiologist at the Division for HIV/AIDS Prevention at the Centers for Disease Control and Prevention. So far, he adds, about 20,000 of the home tests have been sold.
The telephone counseling provided by test makers gets good marks from Branson, who says the counselors "give pretty good service," and from test buyers as well, who are staying on the line from 20 minutes to over an hour, one test-maker says. Finally, home testers seem to be coping with the kits’ lancets well enough, and in 99% of cases are getting adequate blood samples, one company reports.
Preliminary reports from the products’ makers indicate the rate of seropositivity among users is between 1% and 1.5%. "That’s higher than we’d expected," Branson says. The overall prevalence rate for HIV seropositivity stands at 2%, he adds. But the 2% figure represents data from publicly funded test sites, which target patients considered to be at high risk for infection.
The three tests on the market are Confide, distributed by Direct Access Diagnostics of New Brunswick, NJ (a subsidiary of Johnson and Johnson); and two tests, Home Access and Home Access Express (an express-mail variation of the first product), both sold by Home Access Health Corporation of Hoffman Estates, IL.
"The response has been very broad-based," says Arisa Cunningham, director of marketing for Confide. "We have had great response among African-Americans, Hispanics, and gay men. That is a mirror of the groups hit hardest by the epidemic." The age of customers ranges primarily between 18 and 34 years old, she adds. The purchasers’ addresses tend to be more concentrated in certain urban centers, she says.
A spokesman for Home Access Health tells basically the same story. "We think the main group buying our product is the group hardest-hit by the epidemic," says Kevin Johnson, director of communications for Home Access Health Corporation. "This group has been waiting for home testing. They’ve wanted it. They’re the low-lying fruit, if you will, and they’re what’s driving sales."
Sixty percent of the Home Access tests are sold to men aged 24 to 35 years — "slightly higher than we’d thought," Johnson adds.
Both companies are required by the Food and Drug Administration to gather demographic data on users, and to report that information to the CDC, Branson says. The difference in the way the two companies collect that data has to do with timing: Confide’s makers ask users questions related to demographic traits and risk behaviors after they call for test results, while Home Access users are quizzed on such subjects beforehand, when they first register their identification number.
Branson says he’d prefer that both companies place the survey up front, not at the back end of the process. "My guess is that [Confide’s makers] aren’t going to get as good a rate of participation," he says. So far, he’s been proved right.
Cunningham says only about 66% of Confide purchasers are agreeing to do the survey, which targets all those with positive test results but only some users who test negative. The CDC needs data from both sets, Branson notes.
Home Access purchasers, by comparison, participate in the user surveys at the rate of 80%, says Johnson, even though they can bypass the automated survey by "pounding through."
Home tests provide counselor access
The makers of both tests tout two advantages their home-use products offer users: answers, and consistent access to qualified counselors. "In publicly funded test sites, there is only a 67% return rate for test results," says Cunningham. "We have a 96%-plus response rate." That comparison must take into account the fact that most HIV testing is not done in publicly funded sites, which account for only 7% to 10% of all HIV testing, Branson says.
As for access to counselors, both companies emphasize the high quality of service they provide (under FDA onus, it must be noted). According to the CDC’s National Health Information Survey, most people who get HIV tests in a context other than through a home test kit report they don’t get any counseling at all, Cunningham says.
"That’s terrible! We feel that by offering professional counseling, we’re making it easier for people to get information, and to develop plans that are beneficial to them," he says. At Home Access, Johnson agrees: "At some places, you might counseling on the level of a 2, at others a 10. Here, even though it’s not face to face, you get a consistent 8."
Branson says that to some degree, he’s been won over by the concept of phone counseling as well. "They do have pretty good service," she says. "I’ve been in touch with some of the counselors, and they’re pretty dependable."
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