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What Is the Role of HIV Testing at Home?

Is home HIV testing feasible?

Home-access testing for HIV met with virtually unanimous opposition when it was first proposed.¹ Today, the Centers for Disease Control (CDC), leading clinicians, gay activists and AIDS advocates have all endorsed home access testing.² The barriers to home access testing have not been technical, as feasibility studies have demonstrated.³ Home testing has been possible for more than a decade. Actually, “home testing” is a little misleading: customers don’t actually get on-the-spot results, the way they do with home test kits for glucose, cholesterol, blood pressure or pregnancy. The tests are really at-home “collection kits” to be purchased over the counter or through the mail. A test kit purchaser pricks his/her finger, puts a drop of blood on a piece of blotter paper, sends it off in the mail, then phones for results and counseling after a specified time. In the spring of 1996, the Food and Drug Administration (FDA) approved the first HIV home collection test kit, Confide. The kit, sold by a subsidiary of Johnson & Johnson, was later withdrawn from the market. The FDA later licensed Home Access HIV-1 Test System, manufactured by Home Access Health Corporation of Chicago. This remains the only home collection kit approved for sale by the FDA, although a dozen other unapproved home test kits have been advertised for sale in newspapers and via the Internet. The FDA cautions against the use of these unapproved test kits, which have not been fully evaluated and “do not have a documented history of delivering dependable results.”⁴

How is it different?

It’s an easy way for people to find out if they’re HIV infected. Traditionally, getting tested for HIV has meant a trip to a doctor or clinic, getting blood drawn, then returning for results and counseling. The new home testing kits save two trips to the doctor or clinic. It also makes testing accessible for people who live in rural areas, or inner cities where clinics are scarce, too busy, or a long bus ride away. Home testing also affords privacy. Some people are afraid to visit a clinic or doctor’s office because they fear they will be recognized by neighbors, friends, or family. In a number of studies, at-risk individuals have expressed preference for anonymous systems of HIV testing.⁵ Home testing has the potential for complete anonymity. Offering another testing option is a step toward solving the national problem of inadequate HIV testing. An alarmingly high proportion of those at risk has not been tested for HIV.⁶ Getting HIV test results becomes more and more important as means of bolstering the immune system and staving off opportunistic infections improve. Pregnant women are being encouraged to take voluntary HIV tests in light of studies showing that treating HIV-infected pregnant women with zidovudine (AZT) can reduce the rate of maternal/fetal transmission of HIV by two-thirds.⁷

Are the results reliable? private?

Millions of HIV antibody tests have been conducted using dried blood specimens.⁸ Such testing is highly accurate when laboratory protocols for confirmatory testing and quality assurance mechanisms are followed. False positive results do occur in HIV testing, but at a very low rate. Some test kit blotters mailed to the lab may not have enough blood to test. In such situations, telephone counselors have been trained to advise customers when results are unclear or need further confirmation. Each test comes with a unique identification number, which patients return to the lab with their blood samples. The lab never knows a name. When calling for results, patients identify themselves by this number alone.

Who will get tested at home?

Home access HIV testing may provide reassurance to the “worried well”-people for whom the risk of HIV infection may be quite remote, but are nevertheless seeking reassurance. If such individuals no longer rely on public sources of testing, resources may be freed up for more targeted interventions with those at highest risk.⁹ Sales of home test kits have not been quite as robust as might have been expected from surveys in which people expressed their attitudes and intentions regarding home testing. In its first year, Home Access Health’s sold 152,044 test kits; 148,039 people called to find out their results. The overall HIV seropositive rate was 0.9%.¹⁰ Beyond the denial and psychological barriers to seeking testing, many may find the $30-40 retail cost for home test kits prohibitive. Home test kit companies are working with a variety of public health and community agencies, selling kits at wholesale prices so that home access testing can become part of various prevention outreach strategies.

What are the concerns?

One concern is the adequacy of counseling. At a doctor’s office or clinic, test results are usually delivered in person. If a patient feels overwhelmed, or even suicidal, an expert is there to help. Companies selling home test kits make counselors available, but they will be miles away on the other end of a telephone. As one critic of home testing put it, “a 1-800 number can’t hug you when you’re crying."¹¹ Yet for some people, the remoteness and anonymity afforded by telephone counseling makes it easier to reveal painful feelings or embarrassing information. There is a long tradition with telephone counseling in crisis intervention and suicide prevention. Telephone counseling must be compared to the actual experiences of current HIV testing. For many, counseling is already inadequate or missing altogether. According to data from the National Health Interview Survey (NHIS), a third of those who were tested for HIV antibodies got their results by mail (16%) or telephone (17%).¹² About 2.5 million tests are performed annually at publicly funded test sites. In 1995, 25% of people who tested positive and 33% who tested negative failed to return for their results.¹³ In contrast, 97.4% of buyers of the home test kit called for test results.¹⁰ Another concern is potential abuse of home test kits. Some fear that employers, family members or health providers could send someone’s blood sample to be tested without the person’s knowledge. Laws already exist against testing without consent and discrimination on the basis of HIV status. These statutes need to be enforced; new legal protections may be needed once there is more experience with home test kits.

What are the limitations?

A positive HIV test result does not guarantee access to needed care. As the National Commission on AIDS wrote, “for many impoverished individuals gaining entry into a health care and social service system by means of a ticket stamped `HIV positive’ is still a cruel hoax.”  Nevertheless, this is no reason to discourage people from seeking testing. “The lack of good medical and social services for people with HIV infection is an argument for increasing those services, not denying people access to personal medical information.”¹⁵ HIV testing is not an end in itself. A comprehensive HIV prevention strategy uses multiple elements to protect as many people at risk of HIV infection as possible. The real challenge is to ensure that wherever people are tested they have access to follow-up counseling and care. If they are HIV positive they should receive care to stay healthy, and if they are HIV negative they should receive support to stay negative.

Says who?

1. Anon. Banned at home: an FDA ruling on AIDS test. Time. 1989; April 18:26.
2. Leary WE. Government panel hears call for expanded AIDS testing. New York Times. 1994;June 23:A18.
3. Frank AP, Wandell MG, Headings MD, Conant MA, Woody G, Michel C. Anonymous HIV testing using home collection and telemedicine: a multicenter evaluation. Archives of Internal Medicine. 1997;157:309-314.
4. Center for Biologics Evaluation and Research, Food and Drug Administration (FDA). Testing yourself for HIV-1, the virus that causes AIDS–Home test system is available. 1997;July 25. https://www.fda.gov/vaccines-blood-biologics/hiv-home-test-kits/testing…;
5. Hirano D, Gellert GA, Fleming K, et al. Anonymous HIV testing: the impact of availability on demand in Arizona. American Journal of Public Health. 1994;84:2008-2010.
6. Sweeney PA, Fleming PL, Karon JM, Ward JW. A minimum estimate of the number of living HIV infected persons confidentially tested in the United States. Presented at the Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC) 1997;Sept.-Oct., Toronto, Canada.
7. Conner EM, Sperling RS, Gelber R, et al. Reduction of maternal-infant transmission of human immunodeficiency virus type 1 with zidovudine treatment. New England Journal of Medicine. 1994;331:1173-1180.
8. Gwinn M, Redus MA, Granade TC. HIV-1 serologic test results for one million newborn dried-blood specimens: assay performance and implication for screening. Journal of Acquired Immune Deficiency Syndrome. 1992;5:505-12.
9. Valdiserri RO, Weber JT, Frey R, Trends in HIV seropositivity in publicly finded HIV counseling and testing programs: implications for prevention policy. American Journal of Preventive Medicine. 1998;14:31-42.
10. Home Access Health. http://www.homeaccess.com.
11. Ocamb K. Home HIV testing is near. POZ. 1994;June-July:48-52. (quoting Dennis Ouellet, LA Free Clinic).
12. Schoenborn CA, Marsh Sl, Hardy AM. AIDS knowledge and attitudes for 1992. Data from the National Health Interview Survey. Advance Data. 1994;243:1-15.
13. Centers for Disease Control. Update: HIV counseling and testing using rapid tests–United States. Morbidity and Mortality Weekly Report. 1998;47: 211-5.
14. National Commission on AIDS. Report of the Working Group on Social and Human Issues. Washington, DC: National Commission on AIDS, 1991.
15. Bayer R, Stryker J, Smith MD. Testing for HIV infection at home. New England Journal of Medicine. 1995;332: 1296-1299.

Prepared by Jeff Stryker* *CAPS Updated August 1998. Fact Sheet #11Er

Reproduction of this text is encouraged; however, copies may not be sold, and the Center for AIDS Prevention Studies at the University of California San Francisco should be cited as the source of this information. For additional copies of this and other HIV Prevention Fact Sheets, please call the National Prevention Information Network at 800/458-5231. Comments and questions about this Fact Sheet may be e-mailed to [email protected]. © August 1998, University of California.

¿Que papel juega hacerse la prueba del VIH en casa?

¿será factible el examen casero para la detección del VIH?

Cuando por primera vez se planteó la posibilidad de poner al alcance del público un estuche casero para la detección del VIH, esa se encontró con oposición unánime.¹ Hoy en día los Centros para el Control de Enfermedades (CDC, por sus siglas en Inglés), destacados miembros del sector salud, activistas “gay” y los defensores de la lucha contra el SIDA apoyan la idea del estuche casero para detectar el VIH.² Los estudios que se han hecho sobre la factibilidad de las pruebas caseros han demostrado que no hay barreras técnicas en su uso.³ Se ha podido examinar en casa por mas de una década. Realmente, el nombre “examen casero” tiende a mal interpretarse puesto que la persona no obtiene resultados inmediatos, a como sucede con los estuches caseros para detectar el nivel de glucosa, colesterol, presión arterial y el embarazo. En realidad las pruebas son “estuches para ser recolectados” que se pueden comprar sin receta médica en cualquier farmacia o por medio del correo. El comprador del estuche se pincha el dedo, deposita una gota de sangre en un pedazo de papel absorbente, lo envía por correo y luego llama por teléfono (después de un tiempo específico) para obtener los resultados. En la primavera del 1996, la entidad encargada de administrar las medicinas y los alimentos de los EEUU (FDA), aprobó, Confide, el primer estuche casero para la detección del VIH. El estuche, que se vendió por una empresa filial de Johnson & Johnson, y después fue retirado del mercado. El FDA después aprobó Home Access HIV-1 Test System, que esta manufacturado por la empresa Home Access Health Corporation en Chicago. Actualmente, este es el único estuche para prueba casera que ha sido aprobado por el FDA, aunque varios otros estuches no-aprobados han sido anunciados por vente en periódicos y en el Internet. El FDA previene contra el uso de estuches no-aprobados, que no han sido completamente evaluados y que “no tienen una historia documentada de entregar resultados confiables.”⁴

¿en qué forma es diferente?

Tradicionalmente, hacerse la prueba del VIH ha implicado tener que ir al doctor o a la clínica, sacarse sangre, y después regresar por los resultados y recibir apoyo psicológico. Con el nuevo examen casero se ahorrarían dos viajes. Este método hará posible que las personas que viven en áreas rurales o recónditas de la ciudad en donde las clínicas son escasas, con muchos pacientes o que impliquen un largo viaje en bus se hagan la prueba del VIH. El examen casero también brinda privacidad. Algunas personas no van al doctor o a la clínica por temor a ser vistos por algún vecino, familiar o amigo. En un cantidad de estudios, los individuos que están a riesgo han expresado su preferencia por un sistema anónimo al hacerse la prueba.⁵ El examen casero ofrece el potencial de ser totalmente anónimo. Ofrecer otra opción para hacerse la prueba significa avanzar un paso hacia la resolución del problema nacional que enfrenta el sistema de hacerse el examen del VIH. Una proporción alarmantemente alta de aquellos que están a riesgo (más del 60%) todavía no se han hecho la prueba del VIH.⁶ Obtener resultados del VIH se vuelve cada vez más y más importante ya que el sistema inmunológico necesita fortalecerse y mantener bajo control a las infecciones oportunistas. A las mujeres embarazadas se les anima a hacerse la prueba voluntaria del VIH ya que los estudios demuestran que al suministrárseles Zidovudine (AZT), este puede reducir en dos tercios la tasa de transmisión del VIH de madre a feto.⁷

¿los resultados, son confiables?

Millones de las pruebas realizadas para detectar la presencia de anticuerpos del VIH se han hecho por medio de una muestra de sangre seca.⁸  Este tipo de pruebas son bastante exactas, siempre y cuando se siga muy de cerca el protocolo de laboratorio en cuanto a la confirmación de la prueba y los mecanismos que lo garantizan. Algunos de los estuches enviados al laboratorio para ser examinados puede que no contengan la cantidad de sangre necesaria para conducir la prueba. En estos casos, los consejeros telefónicos van a tener que ser entrenados para aconsejar al cliente cuando los resultados no estén claros o por si necesitan confirmación.

¿quiénes se harán la prueba en casa?

La accesibilidad del examen casero puede brindar mayor seguridad a aquellas personas que aunque el riesgo de infección con el VIH sea bastante remota, andan buscando como reasegurarse. Si estas personas ya no pueden contar con las fuentes públicas para hacerse la prueba, puede ser que estos recursos sean utilizados para poner en práctica mas intervenciones dirigidas a los que se encuentran a mayor riesgo.⁹ Las ventas de los estuches para prueba casera no han sido tan numerosas como se esperaba de acuerdo a los resultados obtenidos de encuestas sobre las intenciones acerca de pruebas caseras. En el primer ano de vente, Home Access Health vendió 152,044 estuches; 148,039 personas llamaron para obtener sus resultados. El índice de resultados seropositivos fue 0,9%.¹⁰ Además de la negación y otras barreras psicológicas, muchos encuentran el costo por menor de $30-$40 por estuche a ser imposible. Las empresas que manufacturan los estuches de prueba casera están trabajando con varias agencias de salud publica y comunitarias, vendiéndoles los estuches al mayor para que puedan utilizarlos en sus campanas de prevención.

¿cuál es la preocupación?

Una de las preocupaciones es lo adecuado del apoyo psicológico. En una clínica u oficina del Doctor, los resultados usualmente se entregan en persona. Si el paciente se siente sumamente abrumado por la noticia, hay un experto presente que le puede ayudar. Las compañías que venden el estuche casero también pondrán consejeros a la disposición, pero estos estarán a millas de distancia en la línea telefónica. A como lo expuso uno de los que critican el examen casero “el número 1-800 no te puede abrazar cuando lloras.”¹¹ Para algunos, lo remoto y lo anónimo de la orientación por teléfono les permite revelar con mayor facilidad sentimientos de dolor o información embarazosa. Además, ya existe una larga tradición en cuanto intervenir por medio del teléfono en crisis y en la prevención del suicidio. La propuesta de brindar apoyo psicológico por teléfono debería ser comparado con experiencias que actualmente ocurren al hacerse la prueba del VIH. Para muchos, la consejería ni es la adecuada, ni existe. De acuerdo a las datos arrojados por el National Health Interview Study (Estudio Nacional sobre la Salud), un tercio de aquellos que se hicieron la prueba del VIH obtuvieron los resultados por correo (16%) o por teléfono (17%). ¹² En los sitios públicos, se hacen cerca de 2,5 millones de pruebas anuales. En 1995, 25% de las personas que tuvieron resultados positivos y 33% de las personas que tuvieron resultados negativos, faltaron de regresar por sus resultados.¹³ Por contraste, 97,4% de las personas que compraron estuches de prueba casera llamaron para obtener sus resultados.¹⁰ Otra de las preocupaciones es el potencial de abuso al que el estuche casero pudiera prestarse. Algunos temen que los patrones, familiares o proveedores al cuidado de salud puedan enviar muestras de sangre sin el consentimiento de la persona. Aunque ya existen leyes que protegen en caso de que se hagan sin el permiso de la persona ya sea por discriminación o por ser VIH positivos. Estos estatutos necesitan ser enforzados; nuevas leyes de protección deberán ser creadas a medida que se adquiere experiencia con el examen casero.

¿cuáles son las limitaciones?

Un resultado positivo a la prueba no garantiza el acceso a los cuidados de salud necesarios. A como lo escribió la Comisión Nacional del SIDA “Es muy cruel que muchos de los pobres crean que van a obtener acceso al sistema de salud y servicios sociales por medio de un diagnóstico VIH positivo.”¹⁴ No obstante, esto no debería impedir que la gente busque como hacerse la prueba. “La falta de buenos servicios de salud y de servicios sociales para las personas infectadas con el VIH es argumento para incrementarlos, no para reducirlos.”¹⁵ Hacerse la prueba del VIH no necesariamente significa el final. El reto mas importante se el de lograr un acceso seguro a servicios de cuidados de salud y de apoyo psicológico continuo para todas aquellas personas que se hacen la prueba. Si estos resultan ser VIH positivos, deberían recibir los cuidados médicos necesarios para mantenerse saludables, y si el resultado es negativo deberán recibir el apoyo necesario para mantenerse negativos.

¿quién lo dice?

1. Anon. Banned at home: an FDA ruling on AIDS test. Time. 1989; April 18:26.
2. Leary WE. Government panel hears call for expanded AIDS testing. New York Times. 1994;June 23:A18.
3. Frank AP, Wandell MG, Headings MD, Conant MA, Woody G, Michel C. Anonymous HIV testing using home collection and telemedicine: a multicenter evaluation. Archives of Internal Medicine. 1997;157:309-314.
4. Center for Biologics Evaluation and Research, Food and Drug Administration (FDA). Testing yourself for HIV-1, the virus that causes AIDS–Home test system is available. 1997;July 25.
5. Hirano D, Gellert GA, Fleming K, et al. Anonymous HIV testing: the impact of availability on demand in Arizona. American Journal of Public Health. 1994;84:2008-2010.
6. Sweeney PA, Fleming PL, Karon JM, Ward JW. A minimum estimate of the number of living HIV infected persons confidentially tested in the United States. Presented at the Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC) 1997;Sept.-Oct., Toronto, Canada.
7. Conner EM, Sperling RS, Gelber R, et al. Reduction of maternal-infant transmission of human immunodeficiency virus type 1 with zidovudine treatment. New England Journal of Medicine. 1994;331:1173-1180.
8. Gwinn M, Redus MA, Granade TC. HIV-1 serologic test results for one million newborn dried-blood specimens: assay performance and implication for screening. Journal of Acquired Immune Deficiency Syndrome. 1992;5:505-12.
9. Valdiserri RO, Weber JT, Frey R, Trends in HIV seropositivity in publicly finded HIV counseling and testing programs: implications for prevention policy. American Journal of Preventive Medicine. 1998;14:31-42.
10. Home Access Health. http://www.homeaccess.com.
11. Ocamb K. Home HIV testing is near. POZ. 1994;June-July:48-52. (quoting Dennis Ouellet, LA Free Clinic).
12. Schoenborn CA, Marsh Sl, Hardy AM. AIDS knowledge and attitudes for 1992. Data from the National Health Interview Survey. Advance Data. 1994;243:1-15.
13. Centers for Disease Control. Update: HIV counseling and testing using rapid tests–United States. Morbidity and Mortality Weekly Report. 1998;47: 211-5.
14. National Commission on AIDS. Report of the Working Group on Social and Human Issues. Washington, DC: National Commission on AIDS, 1991.
15. Bayer R, Stryker J, Smith MD. Testing for HIV infection at home. New England Journal of Medicine. 1995;332: 1296-1299.

Preparado por Jeff Stryker, Traducción Sandra Galvez CAPS Revisado Deciembre 1998. Hoja Informativa 11Sr. Alentamos la reproducción de este documento; aunque, no se admite la venta de copias y UCSF deberá ser mencionada como fuente de esta información. Para obtener copias, llame por favor al National Prevention Information Network al 800/458-5231 o al Internet https://prevention.ucsf.edu/. Estas hojas informativas están disponibles en ingles. Cualquier comentario o pregunta acerca de esta hoja informativa puede ser electrónicamente dirigido al [email protected]. ©Deciembre 1998, University of California.

How is rapid testing used in HIV prevention?

why rapid testing?

It is estimated that 25% of all HIV+ persons in the US do not know they’re infected.¹ Taking an HIV antibody test and knowing one’s HIV status are key to preventing the spread of HIV. Many persons who test HIV+ can access counseling, prevention education, support services and medical care to stay healthy and not progress to AIDS. HIV- persons can access counseling and education to remain HIV-. However, even when people choose to get tested, many never return for their results. In public test sites, up to 33% of clients who test HIV- and 25% who test HIV+ never return for their results.² The rapid HIV test is a new, FDA-approved approach to HIV testing that addresses these issues. Conventional HIV testing has been conducted with needle blood draws or mouth swabs which are sent to a laboratory for analysis. Clients need to return to the test site 1-2 weeks later to find out their results. With rapid tests, clients can take the test, receive counseling, and find out their results all in one visit. This can help increase the number of persons who get tested and reduce the number of persons who don’t return for their results.³ Many government and non-governmental agencies are moving toward rapid testing instead of conventional testing. The Centers for Disease Control and Prevention’s (CDC) Strategic Plan for 2005 seeks to increase the number of HIV+ persons who know their HIV status from 70% to 95%—using rapid testing is an integral part of the plan.1 In California, the goal is to have 80% of all state-funded HIV test sites use rapid tests by the end of 2006.⁴

how is rapid testing done?

Rapid testing uses a finger stick, blood draw or mouth swab to collect samples. The test counselor places the sample in a tube with chemicals to process it, and can read the results in about 20 minutes. Counseling and risk reduction planning with the client can take place during the waiting time, or can be done before or after sample collection. Within 20 minutes, most rapid tests will either be non-reactive—a negative test result—or reactive—a preliminary positive result. Currently, if a result shows preliminary positive, a second conventional blood or oral sample is required to confirm it. Final confirmation still takes 1-2 weeks. National data indicate that with rapid testing, 95% of clients who received a preliminary positive result returned for their confirmatory results.⁵ There are currently four FDA-approved rapid HIV tests in the US: Reveal, OraQuick, Multispot and Uni-Gold.⁶ All tests are extremely accurate, with 99.6-100% sensitivity rates.⁷ Only two of the tests—OraQuick and Uni-Gold—are Clinical Laboratory Improvement Amendment (CLIA) waived. OraQuick Advance uses a mouth swab and can be performed in a wider range of settings and temperatures. Rapid testing can be done in most clinical offices and in a large number of non-traditional health care and outreach settings such as mobile vans, storefronts, shelters, bathhouses,⁸ labor and delivery clinics and emergency rooms. Testing in alternative venues can help increase testing among populations that are mobile or hard to reach, including migrant workers, homeless persons, adolescents and young adults.⁹ Rapid testing can change the way HIV testing is done. Most HIV test sites currently have counselors and separate phelobotomists who take the blood sample. With rapid testing, the test counselor can also take the sample and analyze it. However, in some rapid test sites, counselors do the consent and counseling and someone else still collects the sample.

is rapid testing rapid counseling?

No. One study found no difference in STD rates after counseling with rapid tests and conventional tests.¹⁰ Rapid tests still allow for plenty of counseling time. Counselors have about 20 minutes between taking a sample and receiving the results to provide focused and specific counseling about the client’s real risks and possible exposure to HIV. Rapid testing counseling can be more intense due to the immediacy of getting results.¹¹ Clients who receive a preliminary positive result and must return for their confirmation result may be more prepared to deal with their diagnosis. Clients often have had a week to think about what testing positive means and may be more emotionally prepared to listen to and digest referrals and options the counselors can provide.

can my agency/clinic offer it?

Agencies have several considerations to make before deciding to use rapid testing. The client flow will be different because counselors are involved with each client for longer periods of time than during conventional testing. Agencies have greater responsibility because they are handling blood or oral samples. To do this, most agencies must apply to the government for a CLIA certificate,¹² provide quality assurance, keep records and create documentation. If test counselors are also conducting the test, they may need training to collect and process samples, run controls and track the tests. They will also need in-depth knowledge of referral resources for issues that may emerge in new, more focused HIV counseling sessions. Counselors typically may have concerns about the new testing procedures and counseling initially. After they’ve been trained and have provided a number of counseling sessions, they become more comfortable and often say they wished they had become involved in HIV rapid testing sooner.¹³ In some clinical settings it is easier to implement rapid testing because healthcare workers are used to taking samples, running controls and using universal precautions. However, clinicians may not be used to counseling when testing for HIV,¹⁴ and may need training to develop stronger counseling skills and provide adequate referrals.

what’s being done?

The Metro Atlanta Women of Color Initiative (MAWOCI) brought rapid testing, prevention education and linkage to medical care to African American women in community settings such as churches, college campuses, homeless shelters and public housing. Staff were trained in HIV test counseling, rapid testing and condom demonstrations. To facilitate referrals, MAWOCI mapped local resources, forged alliances with agencies serving women of color and assessed capacity of HIV care doctors and clinics. More than 99% of women returned for confirmatory test results.¹⁵ The introduction of OraQuick in counseling and testing sites throughout the state of New Jersey resulted in an increased number of previously undiagnosed HIV cases as well as an increased number of patients receiving both their test results and posttest counseling. Within the first year, 10,429 patients received the rapid test. Of this group, 99.7% received their test results, compared to 65% before rapid testing.¹⁶ In Seattle, WA, the public health department routinely provides rapid testing to persons at high-risk in bathhouses, needle exchange sites and STD clinics. They made this decision after conducting research showing that more people received their test results with rapid testing and it was more cost-effective than conventional blood or oral fluid testing strategies.⁸ The Night Ministry in Chicago, IL, provides rapid testing in health outreach buses for homeless adults and youth and pregnant and parenting teens. The buses are staffed by a nurse, two HIV test counselors and a minister, and offer general health care, mental health services, STD and hepatitis C screening as well as coffee, cookies and condoms. For clients who test HIV+, the program offers bus cards, telephone calling cards and referrals to physicians experienced in providing HIV care.¹⁷

what is the future of rapid testing?

The future is now. Outside of the US, rapid testing is widely used and confirmatory tests are also done with rapid test, eliminating any waiting period for persons who test HIV+. Manufacturers have been slow to seek approval for tests in the US because the FDA has strict policies about licensing new HIV tests. Rapid testing has been met with great enthusiasm in some areas and great trepidation in others. As federal and state governments increase requirements for rapid testing, resources for training, technical assistance and funding need to increase for the agencies that implement rapid testing. State and federal reimbursement protocols, as well as public and private insurance, need to be changed to encourage rapid testing.

Says who?

1. Centers for Disease Control and Prevention. HIV Prevention Strategic Plan Through 2005. https://www.cdc.gov/nchhstp/strategicpriorities/default.htm 2. Kendrick SR, Kroc KA, Withum D, et al. Outcomes of offering rapid point-of-care HIV testing in a sexually transmitted disease clinic. Journal of AIDS. 2005;38:142-146. 3. Sullivan PS, Lansky A, Drake A. Failure to return for HIV test results among persons at high risk for HIV infection: results from a multistate interview project. Journal of AIDS. 2004;35:511-518. 4. Dowling T. Outreach and prevention rapid HIV testing in non-clinical settings. Presented at the California Rapid Testing Conference. 2004. 5. Kassler WJ, Dillon BA, Haley C, et al. On-site, rapid HIV testing with same-day results and counseling. AIDS. 1997;11:1045-1051. 6. Reveal: www.reveal-hiv.com/  7. Branson BM. Point-of-care rapid tests for HIV antibodies. Journal of Laboratory Medicine. 2003;27:288-295. 8. Spielberg F, Branson BM, Goldbaum GM, et al. Choosing HIV counseling and testing strategies for outreach settings: a randomized trial. Journal of AIDS. 2005;38:348-355. 9. Ellen JM, Bonu S, Arruda JS, et al. Comparison of clients of a mobile health van and a traditional STD clinic. Journal of AIDS. 2003;32:388-393. 10. Metcalf CA, Douglas JM, Malotte CK, et al. Relative efficacy of prevention counseling with rapid and standard HIV testing: a randomized, controlled trial (RESPECT-2). Sexually Transmitted Diseases. 2005;32:130-138. 11. Rapid HIV antibody testing. HIV Counselor Perspectives. 2003; 12:1-8. 12. Centers for Medicare and Medicaid Services. How to apply for a CLIA certificate, including foreign laboratories.http://www.cms.hhs.gov/CLIA/06_How_to_Apply_for_a_CLIA_Certificate,_Inc…(Accessed 4/20/06) 13. Birkhead GS, San Antonio-Gaddy ML, Richardson-Moore AL, et al. Effect of training and field experience on staff confidence and skills for rapid HIV testing in New York state. Presented at the International Conference on AIDS, Bangkok, Thailand. 2004. Abst #MoPeE4103. 14. Tao G, Branson BM, Anderson LA, et al. Do physicians provide counseling with HIV and STD testing at physician offices or hospital outpatient departments? AIDS. 2003;17:1243-1247. 15. Thompson MA, Williams S, Williams K, et al. MAWOCI: a novel program providing transportable prevention education, rapid HIV testing, free CD4+ testing and linkage to medical care for women of color in Atlanta, GA. Presented at the 2003 National HIV Prevention Conference, Atlanta, GA. Abst #M1-G0502. 16. Cadoff EM. Rapid HIV testing increases detection rates and posttest counseling. Presented at the Annual Meeting of American College of Preventive Medicine. Feb 17, 2005. Poster 35. 17. Rapid HIV testing popular with Chicago CBO clients. AIDS Alert. February 2005. 18. Rapid testing for HIV: An issue brief. NASTAD HIV Prevention Update. September 2000.

PREPARED BY TOM DONOHOE* AND JAY FOURNIER *UCLA/PACIFIC AIDS EDUCATION AND TRAINING CENTER May 2005 . Fact Sheet #58E Special thanks to the following reviewers of this Fact Sheet: Bernard Branson, Marc Butlerys, Grant Colfax, Teri Dowling, Emily Erbelding, Shelley Facente, Keith Folger, Carol Galper, Cindy Getty, Patrick Keenan, Sally Liska, Rosa Solorio, Peter Shalit, Freya Speilberg, Deanna Sykes, Barbara Weiser. Reproduction of this text is encouraged; however, copies may not be sold, and the Center for AIDS Prevention Studies at the University of California San Franciso should be cited as the source of this information. For additional copies of this and other HIV Prevention Fact Sheets, please call the National Prevention Information Network at 800/458-5231. Comments and questions about this Fact Sheet may be e-mailed to [email protected]. © May 2005, University of California

¿Cómo se aplica la prueba rápida en la prevención del VIH?

¿por qué se recomienda la prueba rápida?

Se calcula que el 25% de todas las personas VIH+ en EE.UU. ignoran que están infectadas. La clave para prevenir el VIH es hacerse una prueba de anticuerpos del VIH y enterarse si uno está infectado o no. Muchas personas con resultados VIH+ pueden recibir consejería, servicios de apoyo, educación preventiva y atención médica para mantenerse saludables e impedir el desarrollo del SIDA. Las personas seronegativas pueden tener acceso a consejería y educación sobre cómo permanecer VIH -. Aún cuando la gente se hace la prueba, muchos nunca regresan por sus resultados. En los lugares de pruebas que operan con fondos públicos, hasta un 33% de los pacientes que resultan VIH+ y un 25% de los negativos nunca regresan por sus resultados para saber si están infectados o no. Autorizada por la Administración de Alimentos y Medicamentos (FDA siglas en inglés), la prueba rápida del VIH es una forma novedosa que confronta esta problemática. Las pruebas convencionales del VIH se realizan con extracciones de sangre con jeringa o tomas de muestras bucales que se envían al laboratorio para su análisis. Las personas deben regresar de 1 a 2 semanas después para obtener sus resultados. Con la prueba rápida se puede tomar la prueba, recibir consejería y obtener resultados en una sola visita. Esto puede ayudar a aumentar la cantidad de personas que se hacen la prueba y disminuir la cantidad de quienes no regresan por sus resultados. Muchas organizaciones gubernamentales y no gubernamentales se están inclinando por el uso de la prueba rápida en lugar de la prueba convencional. El Plan Estratégico de los Centros para el Control y Prevención de las Enfermedades (CDC sus siglas en inglés) para el 2005 pretende incrementar al 95% la cantidad de personas que conocen su condición respecto al VIH, y el uso de la prueba rápida es una parte integral del plan. En California, la meta es que el 80% de los sitios financiados por el estado utilicen la prueba rápida para fines del 2006.

¿cómo se efectúa la prueba?

La prueba rápida puede hacer uso de un piquete de alfiler en el dedo, de la extracción de sangre con jeringa o de una almohadilla para obtener la muestra bucal. El técnico a cargo de la prueba coloca la muestra en un tubo de ensayo con sustancias químicas para procesarla. Los resultados se obtienen a los veinte minutos o menos. La consejería y la planeación para la reducción del riesgo con el paciente puede hacerse antes o después de obtener la muestra o durante el tiempo de espera. En 20 minutos, la mayoría de las pruebas rápidas proporcionan ya sea resultados negativos (no hay reacción) o bien resultados positivos preliminares (sí hay reacción). En la actualidad, si el resultado preliminar es positivo, se toma una segunda muestra convencional de sangre o bucal para confirmarlo. La confirmación final sigue requiriendo de 1-2 semanas. Datos a nivel nacional indican que con la prueba rápida, el 95% de los pacientes con un resultado positivo preliminar regresaron por sus resultados confirmatorios. En la actualidad, cuatro pruebas rápidas han sido autorizadas por la FDA en EE.UU.: Reveal, OraQuick, Multispot y Uni-Gold. Todas son extremadamente precisas, con tasas de sensibilidad de entre 99.6 y 100%. OraQuick Advance utiliza una muestra bucal y puede efectuarse en una gama más amplia de situaciones y temperaturas. La prueba rápida puede realizarse en la mayoría de los consultorios clínicos y en muchos lugares donde se prestan servicios de salud alternativos y de promoción de la salud, como furgonetas [vans], tiendas, albergues para desamparados, baños públicos, clínicas de obstetricia y salas de urgencias. Realizar pruebas en lugares alternativos puede ayudar a incrementar este servicio entre las poblaciones móviles o difíciles de alcanzar incluyendo trabajadores migrantes, personas sin hogar, adolescentes y adultos jóvenes.

¿prueba rápida significa consejería rápida?

No. Un estudio no encontró diferencia en las tasas de enfermedades transmitidas sexualmente (ETS) al comparar la consejería de las pruebas rápidas y con la de las pruebas convencionales. La prueba rápida permite suficiente tiempo para la consejería. Un consejero tiene alrededor de 20 minutos mientras se toma la muestra y se obtiene el resultado para ofrecer una consejería enfocada y específica a los riesgos del paciente y su posible exposición al VIH. La consejería de la prueba rápida puede ser más intensa pues los resultados se obtienen de inmediato. Las personas que reciben un resultado positivo preliminar deben regresar por sus resultados confirmatorios. Éstas podrían estar más preparadas para lidiar con su diagnóstico pues han tenido tiempo para pensar sobre su resultado positivo y quizá sean más receptivas a las recomendaciones y alternativas que se les ofrezcan.

¿puede mi organización/clínica ofrecerla?

Las organizaciones deben tomar varias cuestiones en cuenta antes de decidir utilizarla. El flujo de pacientes será diferente pues los consejeros están involucrados con cada persona durante periodos más prolongados que cuando se usa la prueba convencional. Existe una mayor responsabilidad debido a que están manipulando muestras de sangre y bucales, por lo que la mayoría de las organizaciones deben solicitar un certificado “CLIA” del gobierno, proporcionar garantías de calidad, mantener registros y generar documentos. Si los consejeros también realizan la prueba, es posible que requieran capacitación para colectar y procesar las muestras, aplicar controles y darle seguimiento a las pruebas. También necesitarán conocer a fondo los recursos disponibles que puedan requerirse en estas nuevas sesiones de consejería que son aún más enfocadas. Al principio, los consejeros tienden a inquietarse un poco por los nuevos procedimientos de la prueba y la consejería, pero después de haber recibido capacitación y ofrecido algunas sesiones, se sienten más cómodos y reportan haber querido realizar esta prueba con anterioridad. En algunas clínicas, es más fácil implementar la prueba rápida ya que el personal de atención médica está acostumbrados a tomar muestras, aplicar controles y tomar precauciones universales. Sin embargo el personal médico quizá no esté acostumbrado a dar consejería de la prueba del VIH y proveer referencias por lo que podría requerir capacitación para ello.

¿qué se está haciendo?

La organización Metro Atlanta Women of Color Initiative (MAWOCI) introdujo la prueba rápida, la educación preventiva y los vínculos con la atención médica para mujeres afroamericanas en lugares comunitarios como iglesias, planteles universitarios, albergues para personas sin hogar y unidades habitacionales para personas de bajos ingresos. Se capacitó al personal en cuanto a la consejería, la prueba rápida y para dar demostraciones sobre el uso del condón. Para referir más fácilmente a sus pacientes, MAWOCI ubicó recursos existentes en la zona, estableció alianzas con organizaciones que servían a mujeres de color y evaluó la capacidad de los médicos y las clínicas para atender a las personas VIH+ . Más del 99% de las mujeres regresaron para obtener sus resultados confirmatorios. La introducción de OraQuick en lugares donde se aplicaba la prueba y se daba consejería en todo el estado de Nueva Jersey resultó en una cantidad mayor de casos de VIH previamente indiagnosticados y un aumento en la cantidad de pacientes que recibieron los resultados de sus pruebas y la consejería. En el primer año, 10,429 personas se hicieron la prueba rápida. De este grupo, el 99.7% obtuvo los resultados, comparado con un 65% que los obtuvo antes de la aplicación de la prueba rápida. En Seattle, Washington, el Departamento de Salud Pública efectúa pruebas rápidas de manera rutinaria a personas de alto riesgo en baños públicos, sitios de intercambio de jeringas y clínicas de ETS. Ellos tomaron esta decisión después de realizar una investigación que mostró que la prueba rápida era más eficaz y más económica que otras estrategias de prueba convencionales que usaban muestras de sangre o fluidos bucales. La organización The Night Ministry en Chicago, Illinois, ofrece la prueba rápida en autobuses para la promoción de la salud entre adultos y jóvenes sin hogar y adolescentes embarazadas y con hijos. Los autobuses cuentan con una enfermera, dos consejeros de la prueba del VIH y un ministro. Proporcionan atención médica general, servicios para la salud mental, pruebas de ETS así como café, galletas y condones. A las personas con resultados VIH+ les ofrecen tarjetas telefónicas, vales de transporte público y referencias a médicos especializados en el VIH.

¿cuál es el futuro de la prueba rápida?

El futuro es ahora. Fuera de los EE.UU., la prueba rápida se utiliza ampliamente y las pruebas confirmatorias también se hacen con una prueba rápida, eliminando el periodo de espera para las personas que resultan VIH+. Los fabricantes se han demorado en solicitar la autorización para dichas pruebas en los Estados Unidos debido a que la FDA tiene políticas muy estrictas para la concesión de permisos de nuevas pruebas para el VIH. La prueba rápida ha sido recibida con gran entusiasmo en algunas áreas y con bastante aprehensión en otras. Conforme los gobiernos federales y estatales aumentan los requisitos para la prueba rápida; los recursos para la capacitación, la asistencia técnica y el financiamiento para las organizaciones que efectúan la prueba rápida necesitan también incrementarse. Los protocolos estatales y federales para los reembolsos, así como los seguros públicos y privados, necesitan modificarse para alentar el uso de la prueba rápida.

¿quién lo dice?

1. Centers for Disease Control and Prevention. HIV Prevention Strategic Plan Through 2005. https://www.cdc.gov/nchhstp/strategicpriorities/default.htm (Accessed 4/20/06) 2. Kendrick SR, Kroc KA, Withum D, et al. Outcomes of offering rapid point-of-care HIV testing in a sexually transmitted disease clinic. Journal of AIDS. 2005;38:142-146. 3. Sullivan PS, Lansky A, Drake A. Failure to return for HIV test results among persons at high risk for HIV infection: results from a multistate interview project. Journal of AIDS. 2004;35:511-518. 4. Dowling T. Outreach and prevention rapid HIV testing in non-clinical settings. Presented at the California Rapid Testing Conference. 2004. 5. Kassler WJ, Dillon BA, Haley C, et al. On-site, rapid HIV testing with same-day results and counseling. AIDS. 1997;11:1045-1051. 6. Reveal: www.reveal-hiv.com/ 7. Branson BM. Point-of-care rapid tests for HIV antibodies. Journal of Laboratory Medicine. 2003;27:288-295. 8. Spielberg F, Branson BM, Goldbaum GM, et al. Choosing HIV counseling and testing strategies for outreach settings: a randomized trial. Journal of AIDS. 2005;38:348-355. 9. Ellen JM, Bonu S, Arruda JS, et al. Comparison of clients of a mobile health van and a traditional STD clinic. Journal of AIDS. 2003;32:388-393. 10. Metcalf CA, Douglas JM, Malotte CK, et al. Relative efficacy of prevention counseling with rapid and standard HIV testing: a randomized, controlled trial (RESPECT-2). Sexually Transmitted Diseases. 2005;32:130-138. 11. Rapid HIV antibody testing. HIV Counselor Perspectives. 2003; 12:1-8. 12. Centers for Medicare and Medicaid Services. How to apply for a CLIA certificate, including foreign laboratories.http://www.cms.hhs.gov/CLIA/06_How_to_Apply_for_a_CLIA_Certificate,_Inc…(Accessed 4/20/06) 13. Birkhead GS, San Antonio-Gaddy ML, Richardson-Moore AL, et al. Effect of training and field experience on staff confidence and skills for rapid HIV testing in New York state. Presented at the International Conference on AIDS, Bangkok, Thailand. 2004. Abst #MoPeE4103. 14. Tao G, Branson BM, Anderson LA, et al. Do physicians provide counseling with HIV and STD testing at physician offices or hospital outpatient departments? AIDS. 2003;17:1243-1247. 15. Thompson MA, Williams S, Williams K, et al. MAWOCI: a novel program providing transportable prevention education, rapid HIV testing, free CD4+ testing and linkage to medical care for women of color in Atlanta, GA. Presented at the 2003 National HIV Prevention Conference, Atlanta, GA. Abst #M1-G0502. 16. Cadoff EM. Rapid HIV testing increases detection rates and posttest counseling. Presented at the Annual Meeting of American College of Preventive Medicine. Feb 17, 2005. Poster 35. 17. Rapid HIV testing popular with Chicago CBO clients. AIDS Alert. February 2005. 18. Rapid testing for HIV: An issue brief. NASTAD HIV Prevention Update. September 2000.

Preparado por TOM DONOHOE* y JAY FOURNIER *UCLA/PACIFIC AIDS EDUCATION AND TRAINING CENTER Traducción por David Sweet-Cordero Mayo 2005. Hoja Informativa #58S

What is the role of rapid testing for US-Mexico border and migrant populations?

why test for HIV?

Until recently, HIV rates in Mexico and among Mexican migrants in California appeared to be stable and relatively low; however, recent studies show that HIV may be expanding more aggressively in some populations, especially in border communities.¹ One study of 374 young Latino men who have sex with men (MSM) in the San Diego/Tijuana region found high rates of HIV: 19% in Tijuana and 35% in San Diego.² Another study of 1,068 pregnant women in labor in Tijuana found a 1.12% HIV rate.³ Yet a study of 1,041 Mexican migrants at border crossing locations in Tijuana found a 0% HIV rate.⁴ Getting tested for HIV is key to preventing the spread of HIV. Persons who test HIV+ can access counseling, prevention education, support services and medical care to stay healthy and not progress to AIDS. HIV- persons can access counseling and education to remain HIV-. It is estimated that 31% of all HIV+ persons in the US do not know they’re infected.⁵ Border and migrant populations may be at great risk for HIV yet they are less likely to be tested for HIV or return for test results. Many do not have access to (or fear accessing) traditional healthcare systems, lack transportation and frequently change address.⁶

why rapid testing?

Even when people are able to test for HIV, many never return for their results. In public test sites, up to 33% of persons who test HIV- and 25% of persons who test HIV+ never return for their results.⁷ This may be especially true for border and migrant populations because they may not have stable housing or legal status in the US. The rapid HIV test is a new approach to HIV testing that helps address many of these issues. Conventional HIV testing has been done with needle blood draws or mouth swabs which are sent to a laboratory for analysis. Clients need to return to the test site 1-2 weeks later to find out their results. With rapid tests, clients can take the test, receive counseling, and find out their results all in one visit. This can help increase the number of persons who take an HIV test and reduce the number of persons who don’t return for their results.⁸ Rapid testing can be done in most clinics and in non-traditional healthcare and outreach settings such as mobile vans, bars, parks and health fairs. One study of seasonal farmworkers found that men and women were more likely to accept a free HIV test if it used a finger stick and they could get results in 30 minutes.⁹ Many government and non-governmental agencies are moving towards rapid testing instead of conventional testing. The Centers for Disease Control and Prevention’s (CDC) Strategic Plan for 2005 seeks to increase the number of people who know their HIV status to 95%—using rapid testing is an integral part of the plan.3 In California, the goal is to have 80% of all state-funded HIV test sites use rapid tests by the end of 2006.¹⁰

how is it done?

Rapid testing uses a finger stick, blood draw or mouth swab to collect samples. The test counselor places the sample in a tube with chemicals to process it, and can read the results in 20 minutes or less. Counseling and risk reduction planning with the client can take place during the waiting time, or can be done before or after sample collection. There are four FDA-approved rapid HIV tests in the US: Reveal, OraQuick, Multispot and Uni-Gold.¹¹ All tests are extremely accurate, with 99.6-100% sensitivity rates.¹² OraQuick Advance uses a mouth swab and can be used in a wider range of settings and temperatures. Rapid testing can change the way HIV testing is done. Most HIV test sites currently have counselors and separate phelobotomists who take the blood or oral sample. With rapid testing, the test counselor can also take the sample and analyze it, becoming counselor, technician and laboratory all in one. In some sites, test counselors do the consent and counseling and a separate staff person still collects the sample and reads the results.¹³ Within 20 minutes, the OraQuick Rapid test will either be non-reactive—a negative test result—or reactive—a preliminary positive result. Currently, if a result shows preliminary positive, a second conventional blood or oral sample is required to confirm it. Final confirmation still takes 1-2 weeks. National data indicate that with rapid testing, 95% of clients who received a preliminary positive result returned for their confirmatory results.

is rapid testing rapid counseling?

No. One study found no difference in STD rates after counseling with rapid tests and conventional tests.¹⁴ Rapid testing still allows for plenty of counseling time. A counselor has about 20 minutes between taking a sample and receiving the results to provide focused and specific counseling about the client’s risks and possible exposure to HIV. Counseling can be more intense due to the immediacy of hearing results.¹⁵ Clients who receive a preliminary positive result and must return for their confirmation result may be more prepared to deal with their diagnosis. Clients often have had a week to think about what testing positive means and may be more emotionally prepared to listen to and digest referrals and options the counselors can provide. Test counselors need in-depth knowledge of referral resources for client’s that may emerge in new, more focused HIV counseling sessions. Referrals should be specifically tailored to the needs of border and migrant populations, including basic needs such as healthcare, housing, legal assistance and jobs. Materials should be available in Spanish and counselors should have culturally-relevant knowledge and training in migrant and immigrant issues. Because many persons travel back and forth between the US and Mexico, referrals may need to focus on resources in both countries. Counselors typically may have concerns about the new testing procedures and counseling initially, but after they’ve been trained and have provided a number of counseling sessions, they become more comfortable and often say they wished they had become involved in HIV rapid testing sooner.¹⁶

what’s being done?

Rapid testing is relatively new in most border settings. A 2003 survey of 85 border health centers (community and migrant health centers, tribal organizations and programs for homeless people, among others) found that 64 (75%) offered HIV testing. Of these, 45 also provided HIV medication and counseling services. None of the sites in any state offered rapid HIV testing.¹⁷ Currently, San Diego County offers rapid testing, prevention education and linkage to medical care along the Mexico/California border in various settings such as churches, homeless shelters, parks and beaches. Staff members underwent additional training on rapid testing and single-session HIV counseling. Since offering rapid testing at all anonymous test sites, client return rates have increased from 72% to 93%.¹⁸ La Fe CARE Center in El Paso, TX, offers rapid testing at their clinic and through a mobile van that visits gay bars, nightclubs and adult bookstores downtown. The mobile van has two counselors and uses the OraQuick Advanced mouth swab HIV test. The clinic uses the OraQuick finger stick HIV test. Clients prefer getting results quickly and not having a blood draw. Since offering rapid testing, the number of clients testing at La Fe has increased from 500 in 2002 to over 2000 currently.¹⁹

what is the future of rapid testing?

The future is now. Outside of the US, rapid testing is widely used and confirmatory tests are also done with rapid test, eliminating any waiting period for persons who test HIV+. Manufacturers have been slow to seek approval for tests in the US because the FDA has strict policies about licensing new HIV tests. Rapid testing has been met with great enthusiasm in some areas and great trepidation in others. As federal and state governments increase requirements for rapid testing, resources for training, technical assistance and funding need to increase for the agencies that implement rapid testing. State and federal reimbursement protocols, as well as public and private insurance, need to be changed to encourage rapid testing. It is not enough simply to offer HIV testing to Mexican and other immigrants. Persons who test positive will need quality HIV care and treatment, and persons at risk for HIV will need culturally specific education and prevention programs. Because many persons travel back and forth between the US and Mexico, bi-national cooperation is key in addressing these issues to improve public health in both countries.

Says who?

1. Sanchez MA, Lemp GF, Magis-Rodriguez C, et al. The epidemiology of HIV among Mexican migrants and recent immigrants in California and Mexico. Journal of Acquired Immune Deficiency Syndromes. 2004;37:S204-S214. 2. Ruiz, JD. HIV prevalence, risk behaviors and access to care among young Latino MSM in San Diego, California and Tijuana, Mexico. Presented at the Binational Conference on HIV AIDS. Oakland, CA. 2002. 3. Viani RM, Araneta MR, Ruiz-Calderon J, et al. HIV-1 infection in a cohort of pregnant women in Baja California, Mexico: evidence of an emerging crisis? Presented at the International Conference on AIDS, Bangkok, Thailand. 2004. Abst #ThPeC7301. 4. Martinez-Donate AP, Rangell MG, Hovell MF, et al. HIV infection in mobile populations: the case of Mexican migrants to the US. Revista Panamaña de Salud Publica. 2005;17:26-29. 5. Centers for Disease Control and Prevention. HIV Prevention Strategic Plan https://www.cdc.gov/nchhstp/strategicpriorities/default.htm 6. Solorio MR, Currier J, Cunningham W. HIV health care services for Mexican migrants. Journal of Acquired Immune Deficiency Syndromes. 2004;37:S240-S251. 7. Kendrick SR, Kroc KA, Withum D, et al. Outcomes of offering rapid point-of-care HIV testing in a sexually transmitted disease clinic. Journal of AIDS. 2005;38:142-146. 8. Sullivan PS, Lansky A, Drake A. Failure to return for HIV test results among persons at high risk for HIV infection: results from a multistate interview project. Journal of AIDS. 2004;35:511-518. 9. Fernandez MI, Collazo JB, Bowen GS, et al. Predictors of HIV testing and intention to test among Hispanic farmworkers in South Florida. Journal of Rural Health. 2005;2:56-64. 10. Dowling T. Outreach and prevention rapid HIV testing in non-clinical settings. Presented at the Rapid Testing Conference, California 2004. 11. Reveal: www.reveal-hiv.com/ OraQuick 12. Branson BM. Point-of-care rapid tests for HIV antibodies. Journal of Laboratory Medicine. 2003;27:288-295. 13. Kassler WJ, Dillon BA, Haley C, et al. On-site, rapid HIV testing with same-day results and counseling. AIDS. 1997;11:1045-1051. 14. Metcalf CA, Douglas JM, Malotte CK, et al. Relative efficacy of prevention counseling with rapid and standard HIV testing: a randomized, controlled trial (RESPECT-2). Sexually Transmitted Diseases. 2005;32:130-138. 15. Rapid HIV antibody testing. HIV Counselor Perspectives. 2003;12:1-8. 16. Birkhead GS, San Antonio-Gaddy ML, Richardson-Moore AL, et al. Effect of training and field experience on staff confidence and skills for rapid HIV testing in New York state. Presented at the International Conference on AIDS, Bangkok, Thailand. 2004. Abst #MoPeE4103. 17. Donohoe TJ, Ribo A. Border “330″ clinics: a preliminary report on survey data and an inventory & summary of HIV border services. Needs Assessment Report of Pacific AIDS Education and Training Center and Texas/ Oklahoma AIDS Education and Training Center. July 2003. 18. HIV, STD and Hepatitis Branch, San Diego County, CA. (619) 296-2120 19. La Fe CARE Center, El Paso, TX. (915) 534-7979 20. Rapid testing for HIV: an issue brief. NASTAD HIV Prevention Update. September 2000.

PREPARED BY Tom Donohoe* and Jay Fournier *UCLA/Pacific AIDS Education and Training Center May 2005 . Fact Sheet #S58E Special thanks to the following reviewers of this Fact Sheet: Denise Escandon Borntrager, Hector Carrillo, Carol Galper, Maria Teresa Hernández, Steve Trujillo, Rebecca Ramos, Octavio Vallejo, Rolando Viani. Reproduction of this text is encouraged; however, copies may not be sold, and the Center for AIDS Prevention Studies at the University of California San Franciso should be cited as the source of this information. For additional copies of this and other HIV Prevention Fact Sheets, please call the National Prevention Information Network at 800/458-5231. Comments and questions about this Fact Sheet may be e-mailed to [email protected]. © May 2005, University of California