Rapid HIV testing central to new HIV prevention strategy in
the United States
On 17 April 2003, the Centers for Disease Control and Prevention (CDC)
in the United States announced the latest HIV prevention strategy (1). The
new initiative, Advancing HIV Prevention: New Strategies for a Changing
Epidemic, places emphasis on increasing access to early diagnosis of
HIV infection and to prevention and care services. The strategy consists
of four key parts:
Working with government, state, and local health departments, the public
health community, clinicians, professional medical associations, community
based organisations (CBOs), and people living with HIV, the CDC initiative
capitalises on the recently approved OraQuick Rapid HIV-1 Antibody Test
(2). This is a simple, rapid test that can detect antibodies to HIV-1 in
fingerstick whole blood specimens in as little as 20 minutes. To perform
the test, a fingerstick sample of blood is collected with a specimen loop
and transferred to a vial where it is mixed with a developing solution.
The test device, resembling a dipstick, is then inserted into the vial,
and will indicate if HIV-1 antibodies are present by displaying two reddish
purple lines in a small window on the device in 20 minutes (3). With a sensitivity
of 98.5% and a specificity of 100%, OraQuick is comparable to those Food
and Drug Administration (FDA) approved enzyme immunoassays in widespread
use, and as with all HIV screening tests, every reactive result must be
confirmed with an additional specific test. Unlike other rapid tests, OraQuick
can be stored at room temperature, requires no specialised equipment, and
can be used outside traditional laboratory or clinical settings.
The rapid test will be used in projects designed to increase access to
early diagnosis of HIV infection and referral to care services in high HIV
prevalence settings, including correctional facilities. New projects using
the rapid test in non-medical settings will be piloted by CBOs, with the
aim of targeting hard to reach populations who are at high risk of HIV infection
(for example, female sex workers and intravenous drug users).
In preventing mother to child transmission, it is currently recommended
that all pregnant women in the US be tested for HIV before delivery (4).
Under the new initiative, and in addition to promoting these recommendations,
CDC will develop guidance for using the rapid test during labour and delivery,
or for any infant whose mother was not screened prenatally. Timely knowledge
of the mother's HIV status provides opportunities for interventions that
reduce transmission, such as caesarean section and avoiding breastfeeding.
It is of interest to note that this part of the strategy is in contrast
to that of the Netherlands, where it was recently decided to screen pregnant
women for HIV by offering a standard laboratory test on an 'opt-out' basis,
as opposed to offering a rapid test with informed consent (5).
CDC, in collaboration with other organisations, will also publish Recommendations
for Incorporating HIV Prevention into the Medical Care of Persons with HIV
Infection in 2003, which, with demonstration projects, will provide
guidance and management for reducing HIV transmission from those persons
living with HIV. There will be emphasis on partner notification, including
offering rapid HIV testing to partners.
CDC states that through this initiative "every HIV infected person
should have the opportunity to be tested and have access to state of the
art medical care and to prevention services needed to prevent HIV transmission"