Last month, the U.S. Food and Drug Administration approved new rapid blood-testing technology for HIV. The simplified test no longer requires laboratory analysis, enabling clinic staff to deliver test results within an hour. In the Lancet of February 15, Mary Jane Rotheram-Borus, associate director of policy for the UCLA AIDS Institute, and Mark Etzel, policy director for the UCLA Center for Community Health, propose that the improved technology could prompt new models for public HIV testing.
Rotheram-Borus and Etzel suggest new approaches for voluntary HIV testing to modify laborious pre- and post-test counseling. Based on a client's history and test results, clinics could adopt more flexible approaches to counseling. For example, staff could:
- Obtain the person's consent to draw blood and test for HIV antibodies.
- If the test results are positive, the counselor would refer the person to medical care and provide more rigorous counseling about treatment options, community resources and infection control methods.
- If the test returns negative, the staff would simply inform the client of the test results.
Since 1985, the Centers for Disease Control has required every person obtaining a voluntary HIV test to first receive a one-hour counseling session about AIDS risk behaviors. People are told to return one week later to learn their test results. Some 700,000 tests are wasted in the United States because people do not return for results.
"People seek treatment and change their behavior when they learn they are HIV-positive," said Rotheram-Borus. "If people don't return for their test results, they will maintain their behavior, increasing the risk of infecting others through perinatal transmission, sex or needle-sharing."
"The current approach also imposes a burden in countries where AIDS has overwhelmed the medical system," added Etzel. "Local clinics are forced to spend their money on counseling staff instead of needed drugs and treatment. Freeing these resources will open up new services for HIV-infected persons."
