Presented as a poster at the XIII International Conference on AIDS in July 2000 in Durban, South Africa.

High Demand for Point-of-Care Rapid HIV Screening among Young Gay and Bisexual Men

Mary Lou Miller and Steve Martindale.

OBJECTIVE: Federal approval is pending on point-of-care HIV screening devices (i.e. rapid test kits) which provide preliminary HIV antibody results in 15 minutes. As young gay and bisexual men are primary consumers of HIV testing services, we assessed their opinions on rapid HIV screening and documented their experiences in participating in a two-phase clinical trial which tested both the accuracy and the counseling implications of point-of-care HIV screening.

METHODS: In late 1997 we e-mailed a short survey to 159 Vanguard Project participants, of whom 66 (42%) responded. Their views and concerns about rapid testing were tabulated. Over 300 Vanguard participants subsequently took part in a clinical trial to test the accuracy of the rapid test kits. In 1999, 100 Vanguard participants took part in a second phase of the trial, in which patients were provided with their rapid test results, and qualitative data from patients were recorded by the care providers. A follow-up poll of Vanguard participants was then conducted to record their experiences with the two phases of the clinical trial and document how their opinions may have changed.

FINDINGS: Young gay and bisexual men are very supportive of the introduction of rapid HIV screening, as it reduces the waiting period for results. Despite concerns of the potential applications of rapid screening, 82% (54 of 66) were initially supportive of the idea of rapid testing, and participants who took part in the second phase of the clinical trial were almost universally supportive of the rapid screening process. (Additional quantitative and qualitative data will be available after the abstract deadline.)

CONCLUSIONS: Widespread demand exists among young gay and bisexual men for a reduction in the waiting period for HIV test results, and there is consequently a high demand in this population for the introduction of point-of-care rapid HIV screening.

• Rapid HIV test kits [more accurately called "Fast Check HIV 1/2 (whole blood)" or "point-of-care HIV screening devices"] which provide preliminary HIV antibody results in 15 minutes were approved for use in clinical settings in Canada in March 2000. Produced by Montreal-based BioChem ImmunoSystems, these rapid test kits have proven to be as accurate as the standard ELISA lab test.
• The Vanguard Project is a prospective study of HIV incidence and risk factors among 900 young gay and bisexual men between the ages of 15 and 30 in the Vancouver area of BC, Canada. Participants complete annual questionnaires and submit blood samples for HIV testing and storage.

Two Trials: In 1998/99, two trials were conducted in Vancouver using the Fast Check HIV 1/2 device.

1. Canadian Clinical Trial: Both standard and rapid testing was done for all patients, to validate the accuracy of the rapid test kits. Only standard results were given to patients.
2. Vancouver Counseling Trial: The choice of standard or rapid testing was offered to patients, in order to compile recommendations for amending HIV counseling guidelines. If rapid testing was chosen, the results were given to patients within 15 minutes.

• To assess the opinions of young gay and bisexual men toward the intro-duction of point-of-care rapid HIV testing.
• To determine if familiarity with the rapid testing process changes the opinions that young gay and bisexual men hold towards rapid HIV testing.

Vanguard participants were asked their opinions on rapid HIV testing at three intervals: prior, during and after the rapid test Counseling Trial in which they were invited to participate. The first and third surveys were conducted by e-mail; the second survey was done in person by the nurse at the point of care.

Statistical Analysis:

Responses from participants who had undergone a rapid HIV test for which they received the result and those who had not were compared using contingency table analysis. All reported p-values are two-sided.

Survey #1:

Despite concerns of the potential misuse of rapid HIV screening, 82% of respondents were initially supportive of the idea of rapid testing (Table 1). Eight percent felt that it was a bad idea, and a sizable minority (11%) was undecided.

Survey #2:

One hundred Vanguard participants were invited to take part in the Vancouver Counseling Trial, of whom 98 (98%) chose the rapid testing method. Participants who took part in this trial were almost universally supportive of the rapid screening process (Table 2): 97% preferred the rapid test over the standard testing method; and 100% of those who had a rapid test said they would choose rapid testing again.

Survey #3:

Of the 116 participants who responded to the follow-up survey, 50 (43%) had undergone a rapid test for which they received the result. As shown in Table 3:

• Two-thirds of participants who'd undergone rapid testing found it to be less stressful than standard testing, and only eight percent found it to be more stressful.
• 94% of participants who'd had a rapid test found the single counseling session to be sufficient, and not one participant found the counseling to be insufficient.
• Over 90% of all participants who responded think that the introduction of rapid testing is a good idea. (NB: This is an increase from 82% from Survey #1, prior to the clinical trial.)
• Nearly 85% of all participants who responded would choose rapid testing in the future.

Comparison of Survey Results:

As shown in Table 4:

• During and after the Vancouver Counseling Trial (Surveys #2 & 3), almost all participants who had undergone rapid testing said they would choose it again in the future (100% and 98% respectively).
• Participants who have undergone rapid testing were slightly more likely than those who haven't had a rapid test to think that the introduction of rapid testing is a good idea, although the difference is not statistically significant (96% vs. 88%, p=0.184*).
• 98% of participants who have undergone rapid testing would choose it again. Those who have undergone rapid testing were significantly more likely than those who have not to choose rapid testing again (98% vs. 74%, p<0.001*).

* Fisher's Exact Test. All p-values are two-sided.

• The majority of young gay and bisexual men in our sample are supportive of the introduction of rapid HIV testing.
• Rapid testing reduced stress for patients, and patients considered a single counseling session to be sufficient.
• Almost all patients who are familiar with the rapid test preferred it and would choose it over standard testing in the future.
• Those who have had a rapid test are significantly more likely to choose it again in the future.

The authors gratefully acknowledge: The hundreds of Vanguard participants who agreed to participate in the clinical trial and who responded to our requests for feedback; Magda Piaseczny, Amy Weber and colleagues at the BC Centre for Excellence in HIV/AIDS; The Downtown South Community Health Centre; Darrel Cook, Linda Knowles, Daphne Spencer and colleagues at the BC Centre for Disease Control; Yvan Côté and Steve St-Onge of BioChem ImmunoSystems Inc.; and the National Health Research Development Program, Health Canada, for project funding. Poster designed by Steve Martindale. Title artwork by Mark "Atomos" Pilon; reprinted with permission from The Georgia Straight.