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Ideas and Opinions |19 September 2006

Rapid HIV Testing at Home: Does It Solve a Problem or Create One?

Rochelle P. Walensky, MD, MPH; A. David Paltiel, PhD

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Author, Article, and Disclosure Information
  • From Massachusetts General Hospital, Brigham and Women's Hospital, and the Center for AIDS Research, Harvard Medical School, Boston, Massachusetts, and the Yale School of Medicine, New Haven, Connecticut.

    Acknowledgments: The authors thank Kenneth A. Freedberg, MD, MSc, for critical review of the manuscript and Lauren Mercincavage for technical support.

    Grant Support: By the National Institute of Allergy and Infectious Diseases (K23 AI01794, R01 AI42006, and P30 AI060354); the National Institute of Mental Health (R01 MH65869); the Doris Duke Charitable Foundation, Clinical Scientist Development Award; and the National Institute on Drug Abuse (R01 DA015612).

    Potential Financial Conflicts of Interest: None disclosed.

    Corresponding Author: Rochelle P. Walensky, MD, MPH, Division of General Medicine, Massachusetts General Hospital, 50 Staniford Street, 9th Floor, Boston, MA 02114; e-mail, rwalensky@partners.org.

    Current Author Addresses: Dr. Walensky: Division of General Medicine, Massachusetts General Hospital, 50 Staniford Street, 9th Floor, Boston, MA 02114.

    Dr. Paltiel: Yale School of Medicine, 60 College Street, New Haven, CT 06520.

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In November 2005, a U.S. Food and Drug Administration (FDA) advisory panel reviewed testimony regarding approval of OraQuick ADVANCE 1/2 (OraSure Technologies, Inc., Bethlehem, Pennsylvania), the first truly over-the-counter home HIV testing kit (1). The previous test, Home Access HIV-1 Test System (Home Access Health Corp., Hoffman Estates, Illinois), was approved in 1996 and was actually a home sample collection system. Results were available by telephone 3 days after a dried blood spot was submitted by mail. OraQuick provides accurate, private detection of infection with HIV-1 and HIV-2 in 20 minutes using a simple cheek swab. Public endorsement of home HIV testing has been overwhelmingly positive, a radical change from when the idea was first presented to the FDA in 1986 (1, 2). Supporters argue that OraQuick offers personal choice and empowerment, overcoming the principal barriers to identifying the approximately 300 000 U.S. citizens who remain unaware of their HIV infection (3). We believe that this enthusiasm should be tempered with caution.
Preapproval studies of Home Access suggested that it would appeal most to young, high-risk, low-income, nonwhite men (4), a population with infrequent medical encounters and low HIV testing rates (5). However, abstract preferences elicited without reference to risk, circumstance, or price may not predict purchase decisions. We already know a great deal about who will and who will not test at home (6).
Although 79% of persons negative for HIV infection report interest in a home HIV test, favorable responses drop to...
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Walensky RP, Paltiel AD. Rapid HIV Testing at Home: Does It Solve a Problem or Create One?. Ann Intern Med. 2006;145:459–462. doi: 10.7326/0003-4819-145-6-200609190-00010

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Published: Ann Intern Med. 2006;145(6):459-462.

DOI: 10.7326/0003-4819-145-6-200609190-00010

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2006 American College of Physicians
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