Rapid tests for HIV

Appropriate use

Increasingly, combinations of rapid tests are being used for the diagnosis of HIV in resource-poor settings. Because the consequences of a positive HIV test are so severe, the sensitivity and specificity requirements of these tests are close to the “gold standard”— the performance standard of the best laboratory tests.
The main advantages of using rapid tests for HIV diagnosis are speed and cost. Because a large percentage of patients never return for test results, providing results at the time of testing leads to improved intervention. Rapid tests can be less expensive to purchase, require less infrastructure, and do not need trained laboratory staff. These factors constitute significant savings for HIV testing programs.

The US Centers for Disease Control and Prevention (CDC) has investigated the use of rapid HIV tests both in the United States and in developing countries. Rapid HIV tests were shown to be appropriate for a variety of settings, to increase demand for voluntary counseling and testing (VCT), and expand outreach capacity.

Because of the severe consequences of HIV and the stigma attached to a positive diagnosis, testing for HIV status is often done as part of a VCT process. VCT includes pretest counseling in which the person being tested is told about HIV infection and AIDS; discusses their individual risk factors for infection and how these can be minimized; learns about the testing procedure; and considers the consequences of a positive test result. An informed decision (by the client) must be made before testing. Those who test negative must be reminded of the limitations of the test results and taught how they can reduce their future risks. Those testing positive will need emotional support, information on how to avoid infecting others, referrals to other support or treatment services, and partner notification information.

In 2006, the CDC revised their recommendation so that within the United States, it may be suitable to test individuals aged 13 to 64 visiting health clinics for HIV. However, patients have the option to refuse testing. The new guidelines also highlight that, in some cases, HIV testing can be performed without the need for pretest counseling or written informed consent. Wide scale implementation of this policy has yet to occur.

The Joint United Nations Programme on HIV/AIDS (UNAIDS)/World Health Organization (WHO) policy on HIV testing regards confidentiality, counseling, and consent as the cornerstone of testing principles. They are recommending the following types of HIV testing:

  • VCT for client-initiated testing.
  • Testing in individuals presenting with signs of HIV-related disease or AIDS.
  • Provider-initiated testing in sexually transmitted infection (STI) clinics, antenatal screening, and in asymptomatic individuals seen at clinics that serve communities with a high prevalence of HIV and that have access to antiretroviral treatment.
  • Mandatory screening of HIV of all blood products destined for human use.

Provider-initiated testing must ensure the patient reserves the right to refuse testing or “opt out” of a systematic offer of testing. Mechanisms must be in place to promote post-test counseling as well as medical, psychological, and social support. In this case, the pretest counseling found in VCT centers is adapted to allow for informed consent without the education and counseling portion.
More information on appropriate uses for rapid HIV testing:

  • UNAIDS HIV Testing Policy
  • Rapid HIV Testing
    This CDC web site provides an overview of rapid HIV testing and links to a collection of abstracts, posters, and presentations presenting research studies investigating application of rapid HIV testing for different settings.

The following public-access articles are available: