The Associated Press - Sun, 19 Mar 95
Rochelle Hines; Associated Press Writer

A computer program to help a person decide whether to be tested could be one answer to that awkwardness. Some health officials agree that it has merits but say they aren't certain it is right for every situation.

The program is the vision of social scientist Michael Wright. In 1987, after his job ended as a health planner in Oklahoma City, Wright decided to try to develop a program to help people assess their risk for AIDS. Fortunately, he had some savings, a computer, printer and office furniture.

"It occurred to me that a private, anonymous encounter with a nonjudgmental computer would be a good strategy to help people make a decision about whether to be tested for the HIV antibody," Wright said recently from his Norman office.

Wright, who has a master's degree in sociology from the University of Oklahoma, is developing the program with a $357,000 grant from the National Cancer Institute's Small Business Innovation Research Program.

The institute is interested in the research because one of the more common diseases associated with AIDS is Kaposi's sarcoma, a tumor of the blood or lymphatic vessel walls.

The HIV Computer Risk Assessment Service is available at no charge to people with a Touch-Tone telephone in the Oklahoma City and Dallas-Fort Worth metropolitan areas.

A recorded voice asks the caller for a sexual history dating to 1980, blood transfusion history before 1985, and injecting drug use history.

The computer analyzes the information supplied by the caller and provides advice on whether that person is at risk of current HIV infection.

The advice is based on a number of variables, including the caller's number of sexual partners, frequency of sexual intercourse, type of sexual intercourse and estimated frequency of condom use, Wright said.

The variables are cross-checked with local HIV prevalence estimates and estimates of infectivity of the virus.

During a demonstration, Wright dialed up the service and gave answers fitting the description of a male, intravenous drug user who had sex with a man at specific risk for HIV infection. The man also had a blood transfusion prior to May 1985.

The computer advised the caller to take an HIV antibody test and that the caller was at risk for the Hepatitis B virus. It told him he could get a vaccine for the disease if he was not already infected.

Callers are also told that the assessment is not a substitute for a medical test and are given a listing of several sites in the Oklahoma City and Dallas-Fort Worth metropolitan areas where they can go for tests.

Bill Pierson, chief of the HIV-STD Service for the Oklahoma Department of Health, said the computer was a good approach to trying to cut down on the rate of false positives, or results that inaccurately indicate the presence of HIV antibodies.

Wright said his program would help achieve that goal, because testing people in low-prevalence groups can produce higher false positive rates since people in those groups shouldn't be tested at all.

However, Pierson said he was concerned about whether "talking to a machine and punching some numbers is going to really alleviate the fears."

He said that "most times, there's something that has caused people to have concern, they've heard something, or they've seen something and they want to assess that risk."

Talking to a person helps in those situations, he said.

Wanda Jones, acting associate director for Women's Health from the Office of HIV-AIDS at the federal Centers for Disease Control and Prevention, agreed that false positives are a concern. But the first screening test, the ELISA (Enzyme-Linked Immunosorbent Assay), when combined with the Western Blot test "are probably the closest thing to perfect of any medical diagnostic test on the market," she said.

Literature from the CDC suggests that the testing facility should do the ELISA twice and use the Western Blot to confirm the results.

Ms. Jones said health officials look at the ELISA as a funnel.

"By the time we're finished, the overwhelming majority of results that make it to the end that are called positive, virtually 100 percent are positive," she said.

The CDC has estimated the odds of a false positive HIV antibody test are less than 5 in 100,000.

Wright, whose grant with the National Cancer Institute expires in September, said he eventually would like to make the program available for people to purchase from him or market it to government health agencies, which would contract with him to offer the service free to the public.

Copyright 1995/The Associated Press. Reproduced with permission. Reproduction of this article (other than one copy for personal reference) must be cleared through the Permissions Desk, The Associated Press, 50 Rockefeller Plaza, New York, NY 10020.

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Copyright © 1995 - Associated Press. Reproduction of this article (other than one copy for personal reference) must be cleared through the AP Permissions Desk.

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