A Counselor's perspectives on rapid test algorithms for point-of-care HIV testing. San Francisco, CA 2007

Issues: Current CDC guidelines for rapid HIV testing recommend that preliminary-positive rapid tests be confirmed with laboratory-based supplemental testing. Despite high specificity, false positive rapid tests occur, are distressing for the client, and discouraging for the counselor. Locating clients who don't return for confirmatory results is also challenging, and “preliminary-positive” results may give false hope to clients who don't get confirmatory results or seek medical care. Providing HIV test results in a single session could be one strategy to improve the HIV Counseling Testing and Linkage (CTL) process. Description:We assessed the practical and public health implications of performing additional rapid HIV tests onsite for clients who test preliminary-positive at HIV CTL sites in San Francisco, CA. Over 100 counselors and staff at 5 CTL sites were trained to conduct up to two additional rapid tests and provide counseling for clients whose additional rapid test results indicated that they were likely to be infected with HIV, or were most likely false-positive on the initial rapid HIV screening test. Lessons Learned:Adding additional rapid tests at the point-of-care helps quickly differentiate between true- and false-positive results. This immediate differentiation is helpful in counseling clients during receipt of their HIV test results, and also provides the benefit of allowing instant referrals for clients testing positive. Recommendations: The benefits to both client and counselor for improving HIV CTR seem clear. However, this study will continue to evaluate the effect of performing multiple rapid tests on our ability to link clients to HIV care.