Thursday, October 13, 2005

Home Test for HIV

Spent the day in a meeting with the Texas AIDS Health Fraud Information Network. One of the things that we are constantly looking at through the task force is home testing kits for HIV that are outright frauds. HomeAccess is FDA-approved, but it requires that the blood sample collected at home be sent to a lab for testing. Right now there simply is no other test that you can take at home and get the results from at home without sending a blood sample to a lab. Anybody who says they have such a test are scamming you.

That may change.

The FDA will look at the matter of allowing OraSure to be used as a home HIV test on November 3. If approved, this will open the door for individuals to perform a simple oral swab, wait a few minutes, and know their status. In a perfect world, that would mean that everyone who is positive would now have the chance for truly anonymous testing and could begin immediately to notify their sexual partners to get tested and and themselves start practicing safer sex. Reality being what it is, this will also mean a nice bundle of profits for the manufacturers from sales to the worried well. [shrug] That doesn't bother me as much as some other elements of reality.

The big argument against true home testing in the past was a mental health issue. The shock of being diagnosed with a life-threatening disease is pretty major. In the case of a disease that also turns you into a social pariah and can lead to a hard death, the temptation to opt out sooner rather than later could be tempting. Advocates in Texas and elsewhere, spoke against unregulated home testing because of concerns about suicide.

That, however, was not the only concern. The current testing system, including the home test that requires that blood samples be sent to a lab, includes several important elements.

Epidemiology is nothing to sneer at. It's more than simply counting cases. It's a means of tracking the disease demographically, geographically, and behaviorally. It's also a means of planning both prevention and treatment. If we know how the epidemic is progressing, then we know more about how to work to prevent its spread. If we know how the epidemic is progressing, then we can better predict the scale of resources that will be needed for treatment. Yes, it's numbers, but it's no game.

The current system, in Texas, requires both pre- and post-test counseling. That requirement is sometimes the victim of various shortcuts, but it's there for a reason. Before a test is administered, the individual can be counseled about risky behavior and advised about ways to reduce the risk. Since many people who are tested do not return for their test results, that is a critical opportunity for counseling. The post-test counseling is an opportunity to link the person who tests positive to a support network at the same time there can be a frank discussion about preventing the further spread of the disease. Pre- and post-test counseling matters--it's a significant component of prevention.

There is yet another element that folks don't always like to think about, but partner notification is extremely important. It's tough enough to go tell someone, "Hey, honey, we have the clap; you should maybe see a doctor." It's much harder to deal with the matter of notifying one's partner(s) about HIV. The current system allows for the public health system to step in for the follow up, both in terms of contact tracing and partner notification.

On the other hand, a large percentage of folks who are positive do not know that they are. A home test might encourage them to test themselves and adopt safer behaviors.

I'd like to be optimistic about this, but I am at least ambivalent. What do you think?

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