Point-of-care testing for HIV: HIV counselling and testing

Abstract

The point-of-care tests appear to be very good for screening. When properly performed, point-of-care tests have performance characteristics comparable with standard tests. They have good user and provider acceptability, and safety. A potential advantage could be that, as more infected individuals learn their status and reduce risk behaviours, HIV transmission will decrease (1,2,12). In 1995, 25% of persons testing HIV positive at American publicly funded clinics did not return for their results (22). Kassler et al (14) found a 23% increase in returns for results with rapid testing. There are fewer data on nonreturns in Canada, but the rate appears to be less, 3% to 19%, from an informal poll of several Canadian testing centres (6). A concern expressed about rapid testing is that it will lead to rapid counselling and even to testing without consent (6). At this time, it is difficult to know what the exact role for point-of-care testing in Canada is. Two suggested uses are the screening of women in labour who have not already had HIV testing during pregnancy and the source patients for occupational exposures. However, one could argue that these are just the situations where informed and voluntary consent cannot be obtained. Also, while it will help in the decision of whether to start postexposure prophylaxis, it will be of limited benefit in the decision of whether to continue. It has also been suggested as an alternative in remote settings. Unfortunately, until timely access to confirmatory testing can be resolved, difficulties persist regarding the implementation of rapid testing in remote areas. Settings where rapid testing may be beneficial include the following: clinics where high risk individuals may be seen and the rate of return for test results is low; drug counselling centres; and sexually transmitted disease and family planning clinics where HIV testing is offered. Currently, standard testing should be employed in Canada, with the exception of certain well defined settings where there are health care professionals trained or experienced in HIV testing and counselling. It is still not clear what these settings are.