S02.2 Overview of Rapid/Point of Care Diagnostic Tests For HIV and Current Challenges Associated with HIV Testing

Abstract

Advances in rapid/point of care testing (RPOCT) for HIV have transformed global capacity to reach individuals who might not otherwise have been tested for HIV, particularly in non-traditional health care settings. In addition to reducing patient anxiety associated with awaiting the results of standard laboratory tests, a positive HIV RPOCT may allow for urgent medical interventions which could in turn reduce the risk of transmission of HIV, e.g. in the mother to child setting and in blood and body fluid exposures. The availability of a rapid test result also has the potential to allow immediate linkage to care and to modify behaviour which might result in reduced transmission of infection. Despite these benefits, RPOCT has also resulted in new challenges to health systems. For example, false positive results create unnecessary anxiety and occasionally, unnecessary medical interventions. The majority of currently available HIV RPOCT detect HIV-1 and sometimes HIV-2 antibody. Some newer test kits include the detection of p24 antigen with the potential to enhance diagnostic sensitivity in early infections. Future research should focus on better combination antigen/antibody rapid assays or rapid tests to detect nucleic acid to improve the diagnosis of early HIV seroconversion and for early infant diagnosis. Another area of unmet need is the accurate detection of infection in individuals who have received HIV vaccine who may screen positive on rapid tests making distinguishing vaccination and disease difficult. Finally, future directions should combine testing for multiple infections (e.g. HIV, HBV, HCV and syphilis) in a single test kit.