QUEBEC CITY — The use of rapid human immunodeficiency virus testing has had a profound impact on primary care settings in New Jersey, Denise Young, M.D., reported in a poster at the annual meeting of the North American Primary Care Research Group.
Because the test doesn't require patients to make a second visit to receive their results, more HIV-positive patients are learning of their HIV status and receiving counseling.
New Jersey, which is fifth in the United States in cumulative reported AIDS cases and first in the proportion of women living with AIDS, introduced rapid HIV testing at publicly funded testing and counseling clinics in November 2003. It is now used in 90 sites throughout the state.
Testing has been done with the OraQuick Rapid HIV-1 Antibody Test (OraSure Technologies, Bethlehem, Pa.), which is approved by the Food and Drug Administration for use with whole blood. It is not approved for serum testing or stored samples.
A whole-blood specimen is obtained via fingerstick or venipuncture and inserted into the testing device, which resembles a home pregnancy test kit. Results are ready in 20 minutes.
This compares with 1–2 weeks for the most commonly used initial HIV test, the enzyme immune assay, confirmed with Western blot or immunofluorescence assay.
Prior to rapid testing, only 65% of patients in New Jersey returned for their results.
In contrast, 99.7% of 25,264 patients screened with rapid HIV testing got their results and received counseling, according to an analysis of state databases through July 21, 2005.
A total of 510 (2%) patients were HIV positive. Of these, 327 (64%) were newly diagnosed, reported Dr. Young, Robert Wood Johnson Medical School, New Brunswick, N.J., and her associates.
Further analysis will determine if the seroprevalence at rapid test sites is the same as at traditional testing sites, or if newly diagnosed patients are getting into treatment services in a timely manner, she said.
It's hoped that by providing the opportunity to engage patients more quickly, the test will help decrease the mortality and morbidity associated with HIV infection.
Rapid testing is also being looked at as a way to lessen racial disparities that currently exist in New Jersey, which has one of the highest HIV infection rates in the nation, she said.
One in every 66 African Americans and 1 in every 171 Hispanics in New Jersey is living with HIV/AIDS, according the New Jersey Department of Health and Senior Services.
The state health department encourages the use of rapid testing for occupational exposures and in pregnant women to reduce the risk of mother-to-child transmission, according to statements from the department. But there are trade-offs. More HIV-positive people will get their results. But some people will receive a false-positive result.
Postmarketing surveillance on the OraQuick test initiated by the Centers for Disease Control and Prevention in September 2003 has identified at least five HIV-infected patients who were incorrectly informed that their rapid HIV test results were positive, according to the CDC's Web site.
Publicly funded sites in New Jersey follow CDC protocol, which recommends that all preliminary positive results with rapid HIV testing be confirmed by Western blot or immunofluorescence assay, Dr. Young said.