The convenience and confidentiality of at-home HIV testing appeals to health advocates and patients alike – but the option has been met with some scrutiny since the FDA-approved home test kit became available four months ago.
Will the tests revolutionize HIV testing and care? OraQuick is touted as the first FDA-approved complete at-home HIV test; though a previous “at-home” kit allowed patients to prick their fingers and mail the sample to a laboratory for analyses, OraQuick – an HIV testing device that resembles a pregnancy test – merely calls for a swab along the gums and 20 minutes to yield results.
They are great tests and I wholeheartedly support their use,” said Dr. Mark Thrun, director of HIV Prevention and STD Control for Denver Public Health. “They allow people to be tested whenever and wherever they want, and in the comfort and confidence of their own home.”
Thrun says the new kits will “ideally, increase the percentage of those who are living with HIV who are aware of their infection,” a compelling goal for HIV activists and experts since people who know they’re HIV positive are far more likely to keep others safe, and seek treatment. But Thrun said there are limitations to the at-home tests – they’re “not quite as accurate as tests performed in medical settings,” he said.
Studies have found the version of the HIV test used in the at-home kit is 99.98 percent accurate at showing a “negative” result if that is the user’s status. But if the user is HIV positive, the test only shows a “positive” result 92 percent of the time. Accurate results also hinge on properly following the kit’s instructions.
“We found that the instructions included with the test are lengthy,” Tim Schuetz said, speaking on behalf of Hey Denver, a local organization that provides free and confidential HIV and STI testing primarily to men who have sex with men in the Denver Metro Area. “The tests are effective, but reading the test results can be confusing, especially if the instructions are not read completely and followed precisely.”
Both Thrun and Schuetz encourage anyone who tests positive using OraQuick – or anyone who tests negative but has the suspicion they’re at high risk for HIV to question the result – to follow up with their doctors or a nearby clinic.
Many HIV/AIDS advocacy groups worry that patients will not seek out appropriate care after testing positive at home. There is also worry that the shock of receiving a positive diagnosis, without a trained and compassionate professional available to explain the implications, may be problematic.
It’s hard to determine, thus far, how many people are following up after using the at-home kit – since it’s hard to track how many people are using the test to begin with.
“Though we may not be asking in the correct manner, I haven’t heard of anyone using the home test as of yet,” Thrun said. “Nor have we seen anyone in our clinic who performed a home test and then followed up with us.”
The “revolutionary test” might not be flying off shelves just yet, and many potential customers still aren’t aware that OraQuick exists. OraSure Technologies, the maker of the at-home kit, has recently begun to combat that with a new TV commercial.
Of course, advertising is not cheap, nor is the cost of running a 24-hour help hotline. So OraQuick has been stamped with a relatively steep price: $40 per test. That can be an obstacle since many at risk for HIV have low incomes.
“Though I think home testing is a great tool,” Thrun said, “tests cost too much to be of benefit to most people at risk for HIV.”
But professionals like Thrun and Schuetz didn’t want to focus on the test’s shortcomings – it’s a big step in the right direction, they said. Both were optimistic that the test may at least mean fewer HIV positive people will go unaware of their status. In the United States, one in five people infected do not know they are living with the virus – and often refuse to seek testing due to the stigma associated with HIV/AIDS.
“We do believe there will be some demand for the in-home tests among the population that does not want to be seen at an AIDS service organization,” Schuetz said. “The positive aspect is that folks will have another way that feels comfortable to learn their status.”