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Rapid HIV testing as the standard of care in an urban OB/GYN clinic: Lessons learned

Keri Monahan, MPH1, Erika Aaron, MSN, CRNP1, Tamora Williams1, and Sandra Wolf, MD2. (1) Division of HIV/AIDS Medicine, Drexel University College of Medicine, 1427 Vine Street, Mail stop 959, Philadelphia, PA 19102, 215-762-2042, keri@drexel.edu, (2) Department of Obstetrics and Gynecology, Drexel University College of Medicine, 1427 Vine St., 7th Flr., Philadelphia, PA 19102

Issues: CDC reports increased prevalence of HIV/AIDS among heterosexual women, and that these individuals are diagnosed later in the course of their disease due to lack of perceived risk. CDC estimates one-third of HIV-infected individuals are unaware of their status, which is a factor in partner and mother-to-child transmission. Offering rapid HIV testing in women-centered settings provides opportunity to increase the number of individuals who know their HIV status.

Description: A rapid HIV testing pilot program was implemented at a Philadelphia outpatient OB/GYN clinic. Voluntary, “opt-out” rapid HIV testing (using the OraQuick Rapid HIV-1 Antibody Test) was implemented as standard of care to patients and their partners. Rapid testing and pre-and post-test counseling are performed by a trained full-time HIV test counselor. Those declining rapid testing are offered conventional HIV testing as an alternative.

Lessons learned: Between 9/2/03 and 1/12/04, rapid testing was offered to 217 patients (87% African American, mean age 26 years). 72% accepted the rapid test; 99.5% received results. Of 61 patients who declined, 10 were tested using the conventional ELISA, one of whom tested positive was linked to care. Reasons for declining rapid testing included: not wanting to wait, lack of perceived risk, preference to be tested at future visit. An unexpected finding was that patients were significantly more likely to accept rapid testing if offered by HIV test counselor, as opposed to by medical provider.

Recommendations: Voluntary, opt-out rapid HIV testing is a feasible strategy for early detection of HIV in an urban OB/GYN clinic.

Learning Objectives:

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

HIV/AIDS Research Roundtable: Perinatal HIV Testing and Prevention

The 132nd Annual Meeting (November 6-10, 2004) of APHA