Magazine article Clinical Psychiatry News

Rapid HIV Testing in Offices Poses Challenges

Magazine article Clinical Psychiatry News

Rapid HIV Testing in Offices Poses Challenges

Article excerpt

MIAMI -- Rapid testing for HIV infection in private practice has some clear advantages, but it also brings challenges in terms of staff training, office logistics, privacy requirements, and potential increased liability.

That's what clinicians concluded more than 6 months after implementing a rapid testing program at the South Beach AIDS Project Inc., a testing and counseling center in Miami Beach.

Office staff must be trained on how to perform pretest and posttest counseling as well as the test itself. Some rapid tests require a blood sample from a fingerstick or venipuncture--the OraQuick whole blood test, MedMira Reveal, or Uni-Gold Recombigen tests. The OraQuick rapid HIV-1 antibody test for use with oral fluid (OraSure Technologies Inc.), approved in March by the Food and Drug Administration, requires an oral fluid sample.

One of the biggest benefits of rapid HIV testing--getting a result in 20-40 minutes--also sets up one of the biggest challenges in terms of counseling. Anxiety can be much higher with a rapid test. When asked if they are ready to receive their results in less than an hour, many people will say they are, but they are not, said Alex Prado, director of prevention services at the South Beach AIDS Project.

"I've had a lot of people crying in the waiting room, so that is an issue for counselors," he said at a conference sponsored by the American Foundation for AIDS Research.

Having patients waiting in person for a rapid test result can be an issue in terms of office scheduling or capacity. A visit that includes rapid testing takes about 30 minutes longer per client, Mr. Prado said at the meeting, which was cosponsored by the Florida/Caribbean AIDS Education and Training Center.

The manufacturer's instructions initially recommended reading results between 20 and 60 minutes, but other viral infections were confounding results after 40 minutes, according to Mr. Prado. He suggested setting a timer for 20 minutes and calling the person back quickly to read the results.

He suggested other possible requirements for office-based testing:

* A postexposure prophylaxis plan should be available for staff in offices where rapid testing is done on blood samples.

* Office-based testing does not involve a report from a laboratory, so physicians must decide how to document results and incorporate them into a medical record. …

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