Boost teen HIV testing with free rapid tests

While adolescents are at risk for HIV, many forego testing. This lack of testing is a major public health concern, as more than 50% of HIV-infected adolescents do not know their infection status.1

Good news: Results from new research indicate that teens who are offered free or low-cost rapid HIV testing often are willing to accept the test.2 The study included 81 at-risk adolescents between ages 15-21; more than half of all participants were boys. Overall, 53% of adolescents in the study agreed to receive the free HIV test, with African-American teens more likely to agree to testing compared to Latino youth (75% versus 39%). Researchers note that teens with only one sexual partner were nearly five times more likely to accept testing than their peers with multiple partners, who are at higher HIV risk.2

The Centers for Disease Control and Prevention recommends that healthcare providers routinely offer HIV testing to all adolescents ages 13 and above3, but this recommendation is seldom followed in practice for a variety of reasons says Rebecca Swenson, PhD, a child psychologist with the Bradley Hasbro Children's Research Center and the current study's lead author.

Providers might be pressed for time, not perceive their teen patients to be at risk, or might worry about offending patients by suggesting testing, says Swenson. However, if healthcare providers were aware that more than half of the adolescents would be willing to accept testing, they might be more inclined to offer this service, she notes. "Given that teens in committed relationships are even more likely to accept testing, healthcare providers may present HIV testing to teen patients as a routine health behavior that is part of responsible sexual health care for all couples," says Swenson. "As such, healthcare providers can play an important role in increasing social norms for partner testing among teens." (Use a Centers for Disease Control and Prevention fact sheet,"HIV Testing Among Adolescents," inserted in the online issue, for added counseling information.)

Rapid testing is key

Results from another study published online suggest that while teens and young adults prefer rapid HIV testing that can deliver results in less than an hour, some still worry about whether their tests will be confidential.4 About 40% of those tested said they had some concerns that their parents and health insurers would discover the results.

Readily-available rapid HIV testing can definitely help to increase testing acceptance, says Cathryn Samples, MD, MPH, AAHIV, assistant professor of pediatrics at Harvard Medical School and clinical director of the Boston HAPPENS Program, which provides HIV care and support to youth ages 12-24. "Rapid HIV testing immediately increased both the number of youth testing and the proportion of youth learning their HIV status through our program," says Samples, a co-author of the current online research. "Obtaining results rapidly makes a return visit unnecessary, avoids youth concern about billing for the test, and allows immediate feedback about results and risk and the need for future testing."

While a small grant allowed the Boston researchers to pilot availability of free rapid HIV tests in a large adolescent/young adult clinic setting in 2007-2008, further funding from the state health department maintains rapid testing availability, says Samples. Clinicians continue to find high rates of acceptance for the rapid testing for youth being seen for routine and urgent care, she notes. Grant support also allows the program to offer rapid HIV testing to non-patients, such as the partner or friend of a youth with a sexually transmitted infection (STI), and youth and couples who are seeking HIV testing only.

"I believe rapid HIV testing as a point of care test, similar to pregnancy testing, also fits well in settings focusing on reproductive health and family planning, where it could be offered routinely to new clients and to those needing repeat testing, and where nurses or family planning counselors may be able to be trained to conduct the tests," Samples comments.

Seize the moment

Adolescents often make decisions "in the moment," and rapid HIV testing provides that opportunity with immediate feedback, advises Samples. It is particularly useful when provided in a clinical setting, where reactive results can be confirmed immediately through venous specimen collection, and counseling and immediate access to medical advice also are available, she notes.

"We encourage couples, especially those in new relationships or considering pregnancy, to test together, and availability of barrier-free rapid HIV testing makes that possible," Samples states. "We also have noticed that friends have encouraged other friends to test, once they have been through the experience."

Providers at the Boston clinic strive to normalize HIV testing, as well as repeat testing, for youth who are sexually active or otherwise at risk, working to make it less scary to them and their peers, says Samples. The program offers routine clinician-ordered HIV testing and rapid testing. While both are valuable, rapid health testing is particularly useful for young people who are first time testers, concerned about confidentiality and privacy of insurance billing, anxious about test results, presenting only for HIV or other STI screening, or not otherwise engaged in medical care, she notes. "Our study showed that without universal health care and billing mechanisms to protect privacy, rapid HIV testing may not be self-supporting for adolescents and young adults," states Samples. "If a clinical program lacks grant support and cannot totally support the cost of rapid testing with reimbursement or wishes to decrease financial and confidentiality barriers, partnership with local testing programs, cross-training of support staff, or co-location of testers from other programs may enable successful implementation."

References

  1. Centers for Disease Control and Prevention. HIV Testing Among Adolescents. Fact sheet. Accessed at http://www.cdc.gov/HealthyYouth.
  2. Swenson RR, Hadley WS, Houck CD, et al. Who accepts a rapid HIV antibody test? The role of race/ethnicity and HIV risk behavior among community adolescents. J Adolesc Health 2011; 48:527-529.
  3. Branson BM, Handsfield HH, Lampe MA, et al; Centers for Disease Control and Prevention (CDC). Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR Recomm Rep 2006; 55(RR-14):1-17.
  4. Tuysuzoglu S. Corliss HL, Fitzgerald SM, et al. Acceptability and feasibility of rapid HIV testing in an adolescent clinic setting: youth testing attitudes, knowledge, and behaviors. J Adoles Health 2011; Doi: 10.1016/j.jadohealth.2011.03.007.