North Carolina, United States
A novel rapid POC HIV testing program for people accompanying HIV-positive clients to their appointments effective at diagnosing new HIV infections
Since 2007, the University of North Carolina (UNC) Infectious Diseases Clinic has offered free rapid point-of-care (POC) HIV testing to anyone accompanying an HIV-positive client to their HIV clinic appointment. An evaluation of this testing program showed that testing the companions of people attending the HIV clinic yields new HIV diagnoses and has a high rate of linkage to HIV care.(1)
Companion HIV Testing Initiative
In this program, rapid POC HIV testing is voluntary and advertised through flyers around the clinic. People who accompany a clinic client to their appointment can approach clinic staff for a test. Testing is confidential; the relationship to the client who is being accompanied is not asked and no information about the companion’s test results is shared with the client unless disclosure support is requested. Pre- and post-test counselling is part of the POC test process.
Companions whose POC test is reactive (a provisional positive test result) are scheduled to return to the clinic for confirmatory testing. If the confirmatory test is positive, the person is immediately linked to the clinic, which offers access to primary care providers, social workers, substance-use counsellors and financial assistance counsellors.
Testing program finds 5% positivity rate
Between October 2007 and June 2013, 452 companions were tested. Eighteen percent (72) were first-time testers. Ninety-nine percent (450) received their POC test results on the same day.
There were 22 reactive tests and confirmatory testing was performed for 86% (19) of them). All individuals with a confirmed positive HIV diagnosis were engaged in care at the clinic. Over 70% (16) of companions who tested positive through the program had never tested positive before; the overall positively rate (which included people who were previously diagnosed) was 4.9%.
Program acceptable to general clinic clientele
Between January and April 2009, an anonymous survey was distributed to all clients to assess the program’s acceptability among the general clientele of the clinic.
Four hundred respondents completed the anonymous survey. Ninety-six percent approved of the testing program.
What does this mean for Canadian service providers?
Testing programs that target the social networks of people living with HIV increase access to testing in communities of people who may be at higher risk for HIV acquisition. Social networking programs similar to this one are being used by Saskatoon Health Region to test the social contacts of people recently diagnosed with HIV. In Vancouver, St. Paul’s Hospital offers regular HIV testing to the serodiscordant sexual partners of clients engaged in ongoing HIV care.
The UNC program did not require any new funding and operates using the existing infrastructure and staff. This type of clinic-based HIV testing for companions of HIV-positive clients has the potential to significantly increase the number of people living with HIV who know their status and who are linked to care, and could be replicated in HIV clinics across Canada in provinces where rapid POC testing is available.
Bischof JJ, Bell LL, Pierce JK, Cooper KL, Heine AD, Quinlivan EB, et al. Detecting HIV Among Persons Accompanying Patients to an Infectious Diseases Clinic: Sexually Transmitted Diseases. 2015 Jan;42(1):54–6.