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No Time to Lose: Getting More from HIV Prevention
appropriate counseling, can be an effective strategy for encouraging individuals to adopt risk-reduction behaviors, either to maintain their uninfected status or to prevent transmitting infection to others (e.g., Kamb et al., 1998; Weinhardt et al., 1999; The Voluntary HIV-1 Counseling and Testing Efficacy Study Group, 2000). Because the counseling and testing experience combines diagnostic technology with human interaction, it also offers important opportunities to provide personalized risk-reduction advice and assistance with partner notification, and those who test positive can be linked with needed medical care and social-support services.
Studies conducted in publicly funded testing sites reveal that, on average, approximately two-thirds of individuals tested return to learn their test results and receive post-test counseling (CDC, 1996). One study, for example, found that approximately 26 percent of the individuals tested who turned out to be infected and 33 percent of those who were found to be uninfected did not return for their test results (CDC, 1998). While the return rates may vary by population (e.g., Rotheram-Borus et al., 1997; Valdiserri et al., 1993), the fact remains that a substantial number of people never return to know their HIV status. With standard HIV testing procedures that use an enzyme immunoassay (EIA), there is a one-week to two-week period between the drawing of blood for the test and the availability of the test result.1 Other new HIV tests that use standard diagnostic methodologies for nonplasma fluids (e.g., whole blood, urine, and oral fluid samples) also require approximately one to two weeks to obtain results (Kassler, 1997).
Given the increasing percentage of people who are getting tested for HIV infection (from 18 percent in 1987 to 40 percent in 1995) (Anderson et al., 2000), new testing options that encourage more people to obtain their results may expand the number of individuals who know their status. In contrast, rapid HIV tests deliver results in approximately 10 minutes, enabling health care workers to provide results2 and post-test counseling in the same visit (CDC, 1998). Although several rapid tests have been developed, the Single Use Diagnostic System (SUDS) test is the only such test that is approved by the Food and Drug Administration (FDA) for use
The time lapse with these methods of testing occurs because tests are generally processed in batches in order to decrease testing costs, and because time is needed to conduct confirmatory testing of reactive EIA tests (Kassler, 1997).
A positive rapid-test result is considered a “preliminary positive,” as it has not yet been confirmed using a Western Blot test or immunofluorescence assay. Individuals testing positive would be told of the need for confirmatory testing, but would still be given post-test counseling as if receiving a positive test result (Kassler, 1997).