Quick test, slow start

When a rapid HIV test came on the market two years ago, prevention experts quickly predicted that it would become an important weapon in the fight against AIDS.

The 20-minute test would encourage more people to find out their status and get treatment, reducing their chances of spreading the disease, health officials said. Research has shown that people who realize they are HIV positive reduce risky behaviors by up to 70 percent.

But the test hasn’t lived up to its potential, because – so far – most physicians don’t offer it.

“There’s still a lot of fear and misunderstanding around rapid tests among many doctors,” says Dr. Howard Grossman, president of the American Academy of HIV Medicine.

A study by the academy that is expected to be released next month estimates that only 5 percent of general practitioners around the United States are using the accelerated tests.

The study surveyed 300 doctors in private practices in 10 states with high rates of HIV infection. A manufacturer of the rapid tests, Orasure Technologies Inc., says its sales analysis shows similar results.

Meanwhile, two separate studies released in the New England Journal of Medicine earlier this month suggest the rate of testing in the United States may not be high enough.

The researchers recommended that all adults get tested once and the majority of people get tested every three to five years, much as they would for diseases such as diabetes and hypertension.

The studies concluded that broader testing for HIV may be more cost effective than many common medical tests such as cancer screening or mammography.

Grossman says that broader acceptance of the quick HIV tests in private doctors’ offices is “essential if we are going to reach everyone at risk.”

Although most public clinics and emergency rooms have slowly adopted the accelerated tests, private doctors conduct nearly half of all HIV tests each year and diagnose an estimated one-third of all new HIV cases.

According to the American Academy of HIV Medicine’s survey, many physicians who don’t offer the rapid tests are concerned about how much time it would take to train their staff to conduct the screenings or to counsel patients who discover they are HIV positive.

Doctors are required to counsel patients about risk factors associated with HIV and treatment options for those who discover they are positive before they give them an HIV test.

Another roadblock to widespread use of the tests is doctors’ fear that insurers may not reimburse them. Today, the vast majority of doctors who offer HIV tests use traditional tests and send patients to outside laboratories for blood work.

If doctors were to offer rapid tests, which cost about $10 each, they’d have to pick up the costs and hope insurers cover their bill. But with the standard tests, up to a third of patients typically don’t return to find out whether they have HIV.

At a time when HIV infection rates are climbing in some communities, and holding stubbornly steady in others, the availability of fast and accurate testing is considered vital to controlling HIV infections.

The recent discovery in New York of a possible new strain of HIV that quickly advances to AIDS and is resistant to most available drugs adds further urgency to the need for more testing and more effective prevention strategies.

The rapid HIV test can be done either with a small blood sample from a finger prick or with a newer version that uses a swab of saliva from inside the mouth.

Research shows rapid tests are 99.6 percent accurate and, according to the manufacturer, the tests produce a false positive result 0.2 percent to 1 percent of the time. All patients testing positive for HIV with either test must take another confirmatory test to verify the results.

The Centers for Disease Control estimates that about 900,000 Americans are HIV-positive and that roughly 280,000 of them don’t know it.

Dr. Robert Janssen, director of the CDC’s Divisions of HIV-AIDS Prevention, says the agency is evaluating whether it should expand federal recommendations about who should be tested for the virus.

The CDC is also developing an educational campaign for private physicians about the benefits of rapid HIV tests.

The campaign, which could begin later this year, aims to convince more doctors that the tests can help them screen more of their patients and get those who are sick into treatment earlier.