Acceptance of HIV Rapid Test Slow in Coming

Recent national statistics report that four out of ten people who get tested for the HIV virus in a public health facility, never return to learn their results. Such individuals, momentarily motivated to find the answer to their question, represent a crucial segment of society partially responsible for the continued spread of infection. Fear is the major reason they don't return for their results."People don't want to know ... they are scared of confirmation," says Stephanie O'Sullivan, community relations coordinator for the Kansas City Free Health Clinic.Perhaps in denial or too scared to confirm what they already suspect, these people could start treatments to prolong their lives, control the infection rate by notifying partners and start living a safer lifestyle.In the wake of these statistics, many agencies, including the Center for Disease Control (CDC) in Atlanta, are pushing to integrate faster testing methods into detection and prevention strategies. Technological advances have made it possible to test on-site and provide immediate results.SUDS HIV-1, a rapid blood test, was developed by Murex Diagnostics and has been marketed nationally since 1992. Although approved by the Food and Drug Administration, the test does not fall within the guidelines currently defined by the CDC, which explains why many clinics have not adopted the new method.Traditional testing methods, which also require blood samples, are more complex and can take from three to ten days to process and deliver results. Routing the specimen to the lab is the major time constraint that prevents quicker turnaround and, unfortunately, most testing sites outsource their lab work. Depending on the system the clinic or physician uses, a patient will be wondering about their status for about five days.Kansas City's return rate for AIDS testing is much higher than the national average, with approximately 84 percent of those tested returning for results. David Tritle, of the Comprehensive Immunology Center of Kansas City, notes that "not everyone will show up (to take the test), but those who do have definitely thought about it. And the majority do return for their results."People who choose to test have specific reasons for making their decision. Most have participated in high risk situations and understand there is a possibility that they are infected. The KC Free Health Clinic tests 2,000 clients annually, with 2-3 percent of clients testing positive. The clinic boasts a return rate of 92 percent which O'Sullivan attributes to a non-judgmental atmosphere that offers anonymous and confidential testing.The rapid test is not yet being used in Kansas or Missouri. Resistance in the medical field arises due to many issues. "Rapid testing would obviously invoke a change in training and policies since testing would be performed in the clinic or doctor's office," says William J. Kassler, M.D., of the CDC's Division of STD Prevention, in a recent phone interview. "This could mean substantial expenditures for a small clinic that could break an already maximized budget."Also, the CDC has been slow to realign their recommendations for testing centers, which are guidelines to which most medical professionals respect and conform. The additional purchase of equipment, lack technological expertise, and financial issues are slowing rapid testing's integration into medical circles.Kassler admits it is time to change policy and realign testing guidelines. Emphasizing that the SUDS HIV-1 test is a useful tool and could change the future of HIV/AIDS awareness, Kassler explains there is a great deal of miscommunication associated with the rapid test."The SUDS HIV-1 test is a non-controversial topic within the CDC, and there is no disagreement that this test is very beneficial," he says. "Unfortunately, the wheels of government do not move rapidly, and the CDC's guidelines may be outdated."Not to be confused with a home test, SUDS HIV-1 must be performed in a medical setting and requires a blood sample. The serum or plasma is then processed in a centrifuge and results are delivered in less than 15 minutes. Rapid testing is ideal for presurgical and prenatal screening, emergency care and needle-stick exposure. The greatest concern surrounding the rapid test is the reliability.Although the SUDS test has been about 99 percent effective, it is, however, only a screening device. Benard Branson, of the CDC's HIV/AIDS Prevention division reports that, "six out of 1,000 screening tests offer a false positive, which makes the need for confirmation essential. Rapid testing does not offer a second confirming test, known as the Western blot test, that is more sensitive and prevents incorrect results. If the SUDS test is used, it is necessary to follow up with a second test."Just as patients are preliminarily screened for other health problems, such as cancer, a second test (biopsy) is required to confirm a diagnosis. The same concept is related to rapid testing. Patients should be advised that immediate results are preliminary and a second test should be performed. Health care professionals are trained to communicate this information without alarming patients, and it is the doctor's job to explain risks and possible outcomes of confirming tests and offer options for counselling during the interim.Elisa Dause, public information specialist with the MO Dept. of Health, expresses concern for the welfare of clients who may receive false results. "Referrals for services, such as mental health treatment and medical options, are imperative for rapid testing," she says. Unfortunately, because there is lack of understanding for those who are HIV positive, many health officials worry that patients may risk their job, family and friends over an inaccurate test. It is difficult to pinpoint the repercussions that a false positive (or a false negative) may create, but if the rapid test is kept in perspective it will become one of the most useful tools to combat the spread of AIDS.As the public becomes more aware of HIV/AIDS issues, more people will be tested. In fact, experts have announced that knowledge of HIV infection is much higher than officials expected, reporting that two thirds of Americans infected know of the infection. The CDC estimates that 775,000 Americans carry HIV, and approximately 500,00 have been tested and returned to learn their results.Until rapid testing becomes available in Kansas City and in surrounding areas, other testing options remain available. In addition to traditional testing, OraSure is a reliable method that requires no blood or needles.A collection pad is placed between the lower cheek and gum for two minutes and collects HIV antibodies, not the virus, from tissues in the cheek. Oral testing in extremely accurate and both screens and confirms results. OraSure costs approximately $45 but prices vary at different locations. The KC Free Health Clinic administers all HIV testing at no charge, but accepts donations from clients.It is ironic that the most support for the rapid test comes from the agency (the CDC) that inadvertently limits its use. Until the CDC changes guidelines, most American clinics and physicians will not use the SUDS HIV-1 test. Everyone agrees that the concept of the rapid test is good, but it will take years for bureaucrats and medical professionals to endorse it in good faith. Too many are concerned about incorrect test results, forgetting that all clients are required to follow up with a confirming test.Kassler admits that "for the time being, rapid testing is tied up in red tape," and this tool, that could slow the spread of AIDS, "has been put on the back burner."

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