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CDC Programs for Rapid HIV Testing & Controversy
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Source: Kaiser Daily HIV/AIDS report
http://www.kaisernetwork.org
Seattle health officials today are beginning a "trial run" of a rapid HIV
test in an undisclosed public setting, "raising concern" among some gay and
AIDS advocates about how people will receive their results in public
places, the Boston Globe reports. The local health department hopes that
the trial run using the test, called OraQuick, will lay the groundwork for
a larger program to offer the test in gay bathhouses and sex clubs. The
health department has drafted protocols for using the rapid test in public
settings, and it currently offers the traditional HIV test, which can take
up to a week to get results, in gay venues. The tests are offered in
private rooms and administered by health care workers. Since 1998, the
health department has tested 1,200 men in three gay venues in Seattle,
according to the Globe. Of the 56 men who tested positive -- 4.7% of the
total number tested -- 23%, or 15 men, did not return for their test
results the next week. "If we had been using a rapid test, those ...
people would have at least received preliminary positive results and would
have been informed of the need to return to our clinic for confirmatory
results," Frank Chaffee, HIV/AIDS program manager for the Seattle-King
County Department of Public Health, said (Sanders, Boston Globe, 5/30).
CDC Recommendations
The CDC in April released a revised HIV/AIDS prevention strategy, which
targets the estimated 200,000 people in the United States who are
HIV-positive but are unaware of their status. The agency urged local
health departments to use the rapid HIV test -- which was approved by the
FDA in November 2002 for use in about 40,000 hospitals and clinics with
laboratories -- in all federally funded clinics, as well as places such as
homeless shelters, jails and substance abuse treatment centers. In
February, President Bush announced expanded availability for OraSure
Technologies' OraQuick HIV test, which offers results that are 99.6%
accurate within 20 minutes, to more than 100,000 doctors' offices and
public health clinics. AIDS groups had advocated for making the test more
widely available to the general public. The CDC also recommended
simplifying the pre-test counseling process (Kaiser Daily HIV/AIDS Report,
4/17). However, the CDC does not yet have recommendations on the use of
the rapid test or what type of counseling should accompany the test,
leaving such decisions up to local health authorities. A CDC official,
speaking on the condition of anonymity, said that although the agency is
rethinking counseling strategies, it still believes the process is
important. According to the Globe, the CDC plans to conduct research over
the next year to determine the best ways to combine counseling with the
rapid test.
Working in Counseling
The speed and portability of the new HIV test means that some people may
find out they are HIV-positive in places where counseling and other
services may not be immediately available, Fred Swanson, executive director
for Gay City Health Project, said. Local health officials say that they
can successfully combine counseling and testing in public locations. The
health department has drafted its own protocols for using the rapid test.
"Our big challenge, and one of the big goals for the Centers for Disease
Control, is to try to increase the number of people with HIV infection who
know that," Chaffee said, adding, "One, because people who have HIV and
don't know it are losing the benefits of good medicine. ... And two, we
know from a variety of studies that when people know they have HIV
infection, they are much more careful with their sexual and needle-sharing
partners." Although Washington state law requires pre- and post-test
counseling, the law is not specific as to what the counseling should
entail, according to the Globe. "Are recipients of positive test results
going to be able to internalize the information they've received around the
(new) test when they don't have any time to mull the information over?"
Paul Feldman of Seattle's Lifelong AIDS Alliance asked. Swanson said that
although he is worried about possible negative effects of using the rapid
test in public settings, he said that he is reassured by the fact that the
rapid testing will not occur immediately in gay bathhouses and sex clubs.
"What's exciting to me is that the local health department recognizes that
there may be some challenges, and as such is doing a trial run," he added
(Boston Globe, 5/30).
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