When the U.S. Food and Drug Administration approved OraQuick, the first at-home rapid HIV test, in 2012, it was hailed as an important milestone in the effort to bolster HIV testing among people with restricted access to health clinics, as the Centers for Disease Control and Prevention (CDC) estimates that one in seven HIV-positive people are not aware of their status.
The test allows people to swab the inside of their mouths and see results within 20 to 40 minutes. But, a positive test result with OraQuick still requires a confirmatory test from a doctor's office, and some public health experts have worried that people who used the kit would not visit a clinic for a follow-up test. Now, data from New York City's partner services program indicate that men who have sex with men (MSM) are likely to seek confirmatory testing right away.
The research, which was published in Sexually Transmitted Diseases and led by Chi-Chi N. Udeagu, M.P.H., principal investigator for the NYC Medical Monitoring Project, revealed that, among MSM in New York, 89% sought a follow-up test within a month of a positive at-home test result.
Yet, the test is far from perfect. The kit's price, around $40, means the technology is out of reach for some groups. And the test itself isn't foolproof, with the CDC stating that one false-negative result can be expected out of every 12 tests of HIV-positive people.
Despite these drawbacks, the at-home HIV testing kits are becoming more popular as the public becomes aware of their existence. In fact, when television celebrity Charlie Sheen disclosed his HIV status, sales of OraQuick skyrocketed, increasing 95% that week and remaining elevated during the subsequent four weeks of media coverage, according to a July 2017 paper published in Prevention Science.
For Udeagu and her colleagues, it became increasingly important to evaluate this new technology, as the NYC Health Department's Bureau of HIV/AIDS Prevention and Control is tasked with assisting HIV diagnostics and linking people to care. The Department's Field Services Unit has a number of programs that help people seek testing and treatment privately, including through in-person and telephone notifications.
"The advantage of in-person notification is that our disease intervention specialists (DIS) can offer and provide rapid HIV testing to persons immediately following notification of possible exposure," she told TheBodyPRO.com. "Often, persons decline DIS offers to test on account of recent self-testing or testing at one of the numerous NYC Health Department or other state and federally funded testing sites across New York City available at no cost. Therefore, we decided to verify the claim of self-testing by asking newly diagnosed persons if they had used self-test kits before their laboratory-confirmed HIV-positive test results."
"We also used this opportunity to investigate concerns within the public health circles that persons self-testing positive may delay care or choose not to seek care, or that self-test kits may be cost prohibitive for low-income individuals, many of whom are at high risk of acquiring HIV infection," Udeagu said.
From 2013 to 2016, the researchers interviewed more 8,032 HIV-positive people, both men and women. During the interviews, the researchers asked participants whether they had ever used an at-home self-test. The researchers then identified the demographic characteristics of those who said they had, a group that comprised only 127 of the participants.
Compared with those who had never used an at-home test, those who had were more likely to be male (96% versus 78%), white (46% versus 16%), MSM (92% versus 58%), educated through college or above (67% versus 35%) and living in an affluent NYC neighborhood (51% versus 44%). Among the MSM who took the test and saw a negative result, only 39% sought follow-up laboratory testing.
In sum, the results suggested that that MSM seek timely confirmatory testing and linkage to care after a positive self-test, yet the people using this technology were more likely to be white, male and relatively affluent. The paper pointed to the kit's price, around $40, as a financial barrier that may limit use among those who are most likely to contract HIV.
Udeagu was careful to note that the paper's welcome finding -- that MSM are seeking timely confirmatory testing after a positive at-home test -- may not apply to other demographics because the sample size was small and the study participants were not representative of persons acquiring HIV in NYC or elsewhere with regards to "basic sociodemographics, such as race, gender, income and education." She noted that larger, randomized studies are needed.