Thursday, March 6, 2003

Technology improves HIV testing access


By Peggy O'Farrell
The Cincinnati Enquirer

New technology will make it easier for people to get tested for HIV, and, health experts hope, help contain the spread of the epidemic.

AIDS Volunteers of Cincinnati (AVOC) will start offering free HIV testing outside a doctor's office or public health clinic this spring with two test options - the OraQuick and OraSure tests.

The tests are important options for people who can't or won't go to a clinic or doctor's office to get tested for HIV, experts say.

"We can go to their houses, and that's probably the easiest because you have privacy," says Victoria Brooks, executive director of AVOC. "We can do testing in shelters, recovery centers. We can do tests for homeless people and street youth in any location that would be reasonable, such as a mobile health van. We've done testing with the health department in bars."

The Centers for Disease Control and Prevention reported last month that HIV diagnoses rose 10 percent among heterosexuals in 25 states from 1999 to 2001. HIV cases among men who have sex with other men increased 14 percent during that period. Younger people make up the bulk of the new infections, which emphasizes the need for more public education, researchers said.

About 900,000 Americans are living with HIV, the CDC says. About a third of them don't know they've been infected with the virus. An estimated 6,000 people in Greater Cincinnati are HIV-positive.

Nationally, about 40 percent of people who get HIV tests never return to the doctor's office or clinic for results. Some of those people don't have transportation to get back and forth. Some might not have phones. And some just don't want to know the test results.

But the sooner people know their HIV status, Brooks says, the sooner they can start being treated or change the behaviors that put them at risk for the virus. It also means their partners can be tested for the virus.

The OraQuick is a "finger stick" test, similar to what people with diabetes use to test their blood sugar, that gives results in about 20 minutes. It was approved for use by the FDA in November. The OraSure test is a cheek swab and gives results within two weeks. Both are manufactured by OraSure Technologies of Bethlehem, Pa.

With the OraQuick test, caseworkers will have a "captive audience" during the 20 minutes they wait for the results, Brooks says.

"While they're sitting there, waiting to find out a real life-or-death outcome, even though we try not to categorize HIV as a death sentence, we want to be able to instill in them the information that will allow them to make behavior changes so they're not back to be retested in six months," she says.

Once the test results are available, "we can do two things. We can get them directed into medical care if their result is a preliminary positive. If they're negative, we can continue the conversation about `What is it that put you at risk, and what can we do to change that?' "

A positive result with either method needs to be confirmed with a Western Blot test, says Dr. Carl Fichtenbaum, director of the Infectious Disease Center at the University of Cincinnati.

Nevertheless, the new tests offer quick results and convenience, and those are important advantages, Fichtenbaum says.

"It's a way to get more people tested, and I think we need to get more people tested in our community," he said.

The new initiative marks the first time AVOC has offered HIV testing. The agency primarily has concentrated on educating the public on prevention and providing case management services for HIV and AIDS patients and their families.

Health departments in Ohio and Kentucky already offer the cheek-swab test. In both states, health officials are waiting for guidelines from their state leaders on using the OraQuick test.

The Northern Kentucky Independent Health District routinely uses the OraSure test for outreach testing, says Cathy Kunkel-Mains, who oversees HIV/AIDS outreach and case management.

"One of our outreach educators just did testing at a local bar," she says. "We've also had situations where people will call and we've had them come into the office and get the OraSure test one-on-one because they didn't want to go through the clinics."

There's still a stigma attached to HIV/AIDS and even to getting tested for the virus, says Fichtenbaum. He'd like to see the day when getting tested for HIV and other sexually transmitted diseases is as routine as getting checked for high cholesterol or high blood pressure.

"You don't want to be overweight and you don't want to have a heart attack and you don't want an STD either," he says.

The surge in new cases shows that, despite advances in drug treatments that can keep HIV from turning into AIDS and the rapid testing options, the epidemic is not over.

"We just want people to know that this is still out there, that there is not a cure, that management of this disease is grueling," Brooks says. "It's like being on a lifetime of chemotherapy, literally, with all these toxic drugs. If you might be at risk, let's get you tested. Let's find out where you're at, and let's move forward."

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