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Nov./Dec. 2009
Vol. 19 No. 11
Annual Meeting Coverage
Self Tests for HIV May Be Possible, Opt-Out Testing Has Lifesaving Potential

With more than 200,000 people in the United States living with HIV and not knowing it, the expanded use of HIV testing can connect people with the care they need earlier, when treatment is most effective. Two presenters at the 47th Annual Meeting of IDSA in Philadelphia shared findings highlighting this theme, including the possibility of having people perform their own HIV tests.

In one study, presented during an oral abstract session, investigators asked adult patients in an emergency room setting whether they would be willing to test themselves for HIV, using either an oral fluid or a finger stick test, while waiting for the lab results of an HIV test administered by a health care worker (HCW). Of the 440 patients who were approached, 402 agreed to do so. The self-test results were 99.5 percent accurate when compared with results of the tests performed by HCWs. More than 90 percent of the patients who tested themselves said they would definitely or probably recommend self-testing to a friend.

The findings suggest that an over-the-counter home test for HIV may be possible, said Charlotte A. Gaydos, MS, MPH, DrPH, FIDSA, one of the study’s authors and a professor of medicine at Johns Hopkins University in Baltimore. However, more research will be needed to examine how individuals might react to a positive result from such a test, including seeking a confirmatory positive test and HIV care, Dr. Gaydos noted.

An analysis using computer modeling, meanwhile, suggests that changes in state laws governing HIV testing could save thousands of lives by encouraging earlier diagnosis and treatment. Presented at an oral abstract session, the study quantified anticipated gains in life expectancy if states that currently require opt-out HIV testing, in which patients must provide explicit consent to be tested, instead passed opt-in testing laws, which allow automatic testing unless a patient refuses. More than 600,000 life years could be saved during the lifetime of the current U.S. population if all states adopted opt-in testing, according to the study’s projections, which used data from the U.S. Centers for Disease Control and Prevention (CDC).

“We believe opt-in consent laws are an outdated legacy of the early HIV epidemic, during which informed consent was prioritized over case detection because no treatment was available,” said Michael D. April, DPhil, MSc, a medical student at Harvard Medical School in Boston and an author of the study. He urged legislators in opt-in states to consider the study’s results and revise their consent laws to promote opt-out testing to help diagnose individuals sooner and connect them with care and treatment.

Audio and synchronized speaker slides from sessions at the 2009 IDSA Annual Meeting are available for purchase online.
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