Washington Blade - August 1, 2003
Dwaun Sellers

More health clinics are now using the FDA-approved 20-minute HIV test in the hope it will reduce the chronic problem of people getting tested and never returning to find out the result, according to officials at Whitman-Walker.

Nationwide, almost half of the people who take an HIV test do not return after the two-week waiting period to learn the results. Many might be infected, but wrongly assume someone would have contacted them if they tested positive. As a result, they do not seek out the medical help available to HIV patients.

The OraQuick Rapid HIV-1 Antibody Test, made by OraSure Technologies, is available at Whitman-Walker, one of the first organizations in the country to purchase the OraSure brand test. Research shows that the 20-minute HIV test is 99.7 percent accurate, according to Whitman-Walker officials. The clinic will continue to offer patients the option of the new rapid test or the traditional test that requires a waiting period, but will encourage use of the new test, Cover said.

According to the Department of Health & Human Services, "OraSure Technologies tested the accuracy and ease of the test by having 102 untrained users administer the test at four sites in the United States, including a local AIDS foundation, a program for homeless and low income and community-based HIV organization. These users were able to obtain results similar to those obtained in the firm's original studies done in laboratories."

Previous 10-minute tests were labeled as complicated and difficult to use.

"What makes OraQuick different is that it doesn't require a lab or any kind of equipment," said Michael Cover, Whitman-Walker's associate director for public affairs. "[The test can be administered] by people who are trained to use it and to understand how the test works. The other rapid test available is used in hospital settings because it requires the use of laboratory equipment and specially trained personnel."

Whitman-Walker officials said the quicker test should help ensure that more HIV-positive patients seek treatment.

"The HIV rapid test is going to enable us to boost return rates to 100 percent," said Mike Ellis, director of counseling and testing for Whitman-Walker. "That's the significance of the rapid test, that's the impact that this rapid test is going to have. People will be told then and there and if needed have their blood drawn right then and there."

The test uses a retractable lancet to draw blood from the tip of the patient's finger. A second drop of blood is collected in a small loop device.

The blood sample is stirred in a mixed solution. Once stirred, the testing device's porous pad is inserted into the vial containing the mixture. Initially the window of the test device is pink but clears and reveals a control line, which is the standard. If a second line appears known as the "test line," or t-line, then a second test is done on the person to confirm their HIV-status.

"The trick is reading that t-line because it can be so faint that it's almost impossible to see," Ellis said.

Second test may be required

In most cases, if the test is non-reactive, meaning the person is HIV-negative, then no more testing is required. However, if the test is reactive, then a second drawing of blood is used for further analysis.

"The rapid test is a simple test and that's why we need to do a confirmatory blood draw to make absolutely sure [of its results]. We want to have the most confidence as possible and we want the people who are coming in to get tested to have the most confidence in the veracity of their results," Ellis said.

Some factors exist that might lead to a false positive or a false negative result. If a patient has ever been exposed to Malaria, taken certain kinds of medication, or has other blood diseases, then a false diagnosis can result.

But Ellis expressed confidence in the findings of the OraQuick test.

"The fact is you're 99.7 percent sure that you're HIV-positive if you have a reactive rapid test result," Ellis said. "But here at Whitman-Walker we want to be absolutely sure, so we're going to do a confirmatory blood draw to make sure that the client is HIV-positive."

Ellis, who began counseling in 1981 in New York three years before HIV was discovered in 1984, said that his job took on a special relevance after his partner was diagnosed with HIV.

"About a month and a half after HIV was discovered we learned that my partner of16 years was HIV-positive," Ellis said. "He passed away in 1994 so my involvement has not only been professional but very, very personal."

Ellis trains those interested in becoming volunteer counselors. To administer rapid testing results, a candidate must be a certified HIV-negative counselor, a certified HIV-positive counselor, take a one-day course and then a practicum of reading the results and drawing blood to get results at least six times after an initial dozen tries.

"Right now among our volunteers we have 40 who have participated in the classroom training and been through at least one practicum," Ellis said. "We're hoping to get everybody up to speed by Sept. 1."

"With the incorporation of OraQuick, we really have every counselor that provides this test be prepared and trained to provide an HIV positive result," Cover said, who found out that he was HIV-positive in 1998. "I remember when I got my result I was thankful that the person was trained to handle me."

"It's an important process that we need to ensure that we're willing to offer rapid testing and not make one mistake," Cover said. "We take our jobs very seriously. We have to make sure that we do this absolutely right."

Almost a quarter-million Americans don't know they're infected with HIV and more than 11,000 who have been tested do not return for their results, according to Ellis.

Whitman-Walker has high return rate

At Whitman-Walker, the return rate of those coming back for their results is between 74 and 76 percent, which is 50 percent higher than the national average. The results of those who test positive but neglect to retrieve the results are kept for at least seven years at the clinic but in many cases a lot of these people are tested anonymously and there is no way of tracking them down.

"What's unfortunate is that many of those people believe that even though they've tested anonymously, that we would have found some way to contact them," Ellis said. "Of course there's no way to do that so they think that they're negative because if they weren't then someone would have told them."

Cover stressed that gay men in particular remain at high risk for contracting HIV and noted that 42 percent of AIDS cases are among gay and bisexual men.

"I think the test is just as important an endeavor [as a cure] but it's critical to get people to understand their HIV status and to know what that means in terms of HIV prevention," Cover said. "Our challenge, while the FDA and other research institutions are working on a cure, is to identify those who are HIV positive and get them into care, get them to understand their HIV-infection to help reduce transmission."

MORE INFO

Whitman-Walker Clinic

1407 S St, NW

Washington, DC 20009

202-797-3500

www.wwc.org

030801
WB030803

Always watch for outdated information. This article first appeared in 2003. This material is designed to support, not replace, the relationship that exists between you and your doctor.

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