Rapid HIV test yields counseling, referrals

Clients report satisfaction with rapid test

Recent studies of the rapid HIV test’s use among at-risk populations show that the test can be a valuable tool when combined with counseling in intervention programs because the percentage of people who stay to receive their test results is very high.

The test also has increased demand for HIV testing and counseling outreach programs in communities that otherwise may be difficult to reach or that are at greater risk for the AIDS epidemic.

For example, the AIDS Research Consortium of Atlanta has developed a program called the Metro Atlanta Women of Color Initiative that targets African-American women for HIV testing and counseling at both the consortium’s clinic and at community sites, says Melanie Thompson, MD, principle investigator.

"In Georgia in 2002, 86% of the women diagnosed with AIDS were African-American, and 28% of AIDS cases overall were women," she says. "And within the African-American community and particularly among women, there is a significant stigma against testing."

The program resulted in nearly all participants staying to receive their HIV test results, and greater than 99% said they preferred receiving their HIV test with the rapid testing, Thompson says. "One hundred percent said they’d do it again with the rapid test, and 100% said they’d refer friends for the rapid testing," she adds.

Another recent study evaluating OraQuick rapid HIV testing in high-risk settings also found that the test results reach a high percentage of people being tested. University of Minnesota investigators tested 739 people in Minneapolis for HIV, and all but one person received the test results. The targeted population included people found in chemical dependency programs, homeless shelters, halfway houses, and youth centers.1

The AIDS Research Consortium’s ability to take state-certified counseling and testing staff to local churches, community centers, YMCAs, and other venues to provide HIV prevention counseling before and after results are given from a rapid HIV test has struck a positive cord within the African-American community.

"The response from the community has been overwhelmingly positive," Thompson says. "In fact, we haven’t been able to meet all the demand from community groups that want us to come out and work with them."

Although the program has targeted African-American women, it also has reached at-risk men, who accounted for 29% of the first 300 clients who were tested, she explains.

"What we find is men also want to avail themselves of testing an sometimes will bring their partners with them," Thompson says.

Of the first 300 clients, 80% were African-American; 53% were ages 20 to 29; the annual income was less than $15,000 for 44% of the clients, and 67% had been tested and found negative previously, she adds.

"But 25% had never been tested before, and 20 clients or 7% had been tested previously, but didn’t return for test results," Thompson says. "And when you look at that group of 20 a little more closely, they were all African-American, and two of them tested positive in our program."

This was affirmation that the program was picking up the at-risk people who otherwise might not learn of their HIV status.

Nationally, the Centers for Disease Control and Prevention (CDC) estimates that the percentage of Americans who have been tested for HIV is 45.6%, which includes women who are tested during pregnancy and people who are tested involuntarily due to military service, insurance application, employment, immigration, and other reasons.2

Out of the entire group of 300 included in the study analysis, there were 11 positives (3.7%), Thompson says. Breaking this down by gender, the seroprevalence for the men was 10.3%; and for the women, it was 0.9%. "About 20% of our HIV-positive clients came to be tested because of recent risky behavior," she points out.

The program is designed to do far more than provide HIV testing. Counselors meet with clients during the 20 minutes it takes to process the OraQuick rapid HIV fingerstick test, which is what has been used in the program since March 2003, she says.

"We are still counseling with clients at the time the test comes back." This service all but guarantees a high rate of clients learning their test results, and there was, in fact, only one person who left before the results could be revealed, Thompson adds.

"The first prevention message was that people got their test results, and their knowledge of their serostatus is important in implementing interventions. The second intervention was in the counseling," she adds.

Counselors discussed with clients, as they waited for their results, about HIV, how it’s transmitted, about their own risk behaviors, and how to develop a personal risk-reduction plan.

"We do role-playing with clients about what would happen if they got a positive test," she continues. "We ask them very specific questions like, Who would you call today? What would happen if you told your sexual partner that you are positive? Are you afraid you would be subjected to violence?’"

The role-playing is important because once the test results come back, it’s very difficult for people to think through these scenarios, Thompson says. "We counsel people to come to grips with getting a positive test."

Also, the role-playing serves as an additional prevention message because it’s often the first time that a person has seriously considered what would happen if the HIV test came back positive, she says. "It’s not unusual to see a client cry and experience strong emotions when asked these questions."

The program is fairly unique in that it also includes providing a free CD4 cell count for the people who test positive. "That allows us to triage the emergency of getting someone into care," Thompson says.

Clients who have low CD4 cell counts are referred to services where they could receive antiretroviral treatment and, if necessary, prophylaxis for opportunistic infections.

Six of the 11 people who tested positive in the first group had CD4 counts of less than 350, indicating that they were candidates for anti-retroviral treatment, she notes.

The other aspect of the program links clients to care and is part of the clinical trials consortium, which includes private doctors and health clinics and referrals to the proper health insurance or safety net, Thompson adds.

Also, since the CDC has announced it will focus more intently on providing prevention messages to HIV-positive populations, the program includes counseling for positives to help people with risk reduction, she explains.

This opportunity arrives when the patient is seen at a follow-up session a week after the rapid test. At this meeting, the client is told of the results of a second HIV test that is taken for confirmation purposes.

"Most of the time, they’re willing to give us their name and contact information or to take our name and our counselor’s name and then call that person back," Thompson says.

"We try to keep in contact with that newly diagnosed person over the course of that week, so they have someone to talk to, or so they can call us and we can send them to whatever referral services they might need, including psychiatric care or drug-abuse treatment," she explains.

Thompson says that the rapid test is better from the client’s perspective because the weeklong wait often is difficult, leaving people with a lot of anxiety and fear.

Many studies of HIV testing show a low response rate of people returning for their test results, and the rapid test will capture nearly all of these testing dropouts. Also, HIV counselors have the option of not providing a rapid test’s results to a client immediately if the counselor determines that the client is not in the best frame of mind to hear about a bad result, Thompson explains.

For instance, if rapid testing is offered in a bar, counselors could set an appointment to contact the people the next day when they are sober, she says. "You do have the option of waiting to give the results. Just because it’s a rapid test doesn’t mean the results have to be given back rapidly."

References

1. Keenan P. HIV outreach in the African-American community using OraQuick rapid testing. Presented at the 2003 National HIV Prevention Conference. Atlanta; July 2003 Presentation #T2-1502.

2. HIV Testing — United States, 2001. MMWR 2003; 52 (23):540-545.