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HIV home tests – how will they be used?
Roger Pebody, 2012-07-07 11:10:00
This week the OraQuick In-Home HIV Test, which will be sold over the counter and used without medical supervision, received its final approval from the Food and Drug Administration (FDA), meaning that it can be legally sold in the United States. Similar approvals may follow for other countries. But who is likely to use it and in what circumstances? And will the increased accessibility of HIV testing make any difference to the epidemic?
Whereas French research suggests that men who are secretive about their homosexual behaviour will have a particular interest in home testing, a study from New York indicated that some gay men will use it to test sexual partners, sometimes as a prerequisite for unprotected sex. And a rich discussion between HIV prevention advocates and researchers, which recently took place on the email forum of International Rectal Microbicide Advocates (IRMA), highlighted the key issue of whether people who test positive at home will subsequently connect with health services. While some participants had concerns about the potential for coercion and abuse, others felt that home testing could increase choice and autonomy.
The OraQuick In-Home HIV Test will be sold from October onwards in pharmacies and over the internet, for a price somewhere between $20 and $60. The packaging will include instructions, advice on what to do after getting the result and details of a 24 hour phone helpline. The test's sample is taken by swabbing an absorbent pad around the outer gums, adjacent to the teeth; the results are given in twenty minutes.
At a hearing in May, the members of an FDA advisory committee voted unanimously that the benefits of the test outweigh its potential risks for consumers. While the test is not as accurate as professionally administered tests, the panel felt it could provide an important way to make HIV testing available to more people.
At the FDA hearing, there was overwhelmingly supportive public testimony from HIV activists, black community representatives and public health experts. Nonetheless, in the days that followed, some advocates raised a number of concerns.
For many advocates, a key issue is the support that can be offered by professionals during the testing process. “HIV testing is not a matter of poking the person, sitting quietly for 15 minutes and then sending them on their way without any other discussion,” as someone commented. While testing is going on, there is a dialogue about why the test is being done, what the test is for, what the results mean, safer sex practices and referrals to other services. Moreover, there is considerably more talking should the result turn out to be positive.
Many feel that this personal, direct discussion cannot be replicated with a pamphlet, which may or may not be read and understood.
This puts testing into the hands of the individual, not a healthcare professional
Some people fear that the limitations of the test will not be fully understood. In the trial that led to the test's approval, 7% of people who really did have HIV received false-negative results. Moreover the test has a considerable window period – a negative test result is not considered accurate if a risk has been taken in the previous three months.
But others point out that the window period problem has always been with us. “Many people – perhaps most – assume that all is well after a visit to the local clinic and an antibody negative result,” noted Timothy Frasca of the HIV Center for Clinical and Behavioral Studies in New York. He suggested that people’s behaviour is not necessarily influenced by the cautionary messages they hear from healthcare staff.
A number of advocates felt quite strongly that despite certain limitations of the home test, its key advantage is that it puts testing into the hands of the individual, rather than being controlled by healthcare professionals. “Attempts to overly mediate how I receive information about my body amount to little more than a paternalistic view of what I can handle,” said Jerome Galea of Epicentro in Peru.
Galea went on to say that while many people will continue to want and need in-person counselling and testing, those who do not should not be forced to have it. He said that he’d probably had about 50 tests in the past 25 years and doesn’t need to go through the counselling again.
Source:1
