On June 27, National HIV Testing Day, Susan McCreedy had to sweat out waiting for the results of 15 HIV tests – none of them her own.

In past years, McCreedy, HIV program director for the Des-chutes County Health Department, might have taken 15 blood or cheek samples, then contacted the patients to return to hear their results two weeks later.

But like many county health departments across the country, Deschutes County is now using rapid HIV test kits that provide results in about 20 minutes. That means McCreedy finds out the test results at the same time as the patient.

”That’s an intense experience,” McCreedy says. ”We look at it literally together. My heart beats a little faster when I do that.”

While the new rapid testing may be harder on public health officials, it is considered a watershed development in the HIV/AIDS battle. The rapid tests can be performed virtually anywhere and pretty much ensure that persons who undergo testing get their results.

”The return rate is potentially 100 percent, McCreedy says.

Last month the Centers for Disease Control and Prevention reported on a three year pilot project offering the rapid kits to county health departments and other HIV test sites. Between 2003 and 2005, CDC distributed 800,000 free rapid tests to 230 sites throughout the U.S. In 373,000 rapid tests administered, screeners identified 4,650 new HIV infections.

Of the 48 testing coordinators interviewed during the pilot project, 33 said the rapid tests enabled their organizations to screen more individuals because the clients did not have to return for a second visit to get their results.

The CDC says that with traditional lab testing about 30 percent of persons who test positive for HIV and 39 percent of those who test negative never return to get their test results. McCreedy says about 30 to 35 percent of individuals who schedule an HIV test never show up for their appointment. The rapid tests can be done immediately if a person indicates he or she is willing to be tested.

The rapid HIV tests are now a key prong of national HIV strategies. In 2003, CDC expanded HIV testing recommendations beyond individuals considered at higher risk. The new approach aims to identify more of the estimated 250,000 people who are HIV positive and don’t know it. Public health officials maintain that the vast majority of new HIV infections, up to 75 percent, are transmitted by this infected, but unaware, group.

According to officials at the Kaiser Family Foundation, CDC is expected to release new guidelines this year recommending routine HIV screening for all adults, ages 13 to 64, and repeat annual screenings for those at high risk.

”This year, the message was everybody should know their results, at least once,” McCreedy says. ”That was CDC’s big message and that’s what it said on our poster.”

The FDA has approved two rapid HIV tests that can be used in non-laboratory settings. The tests, which use a drop of blood or some cells scraped from the inner lining of the cheek, can be done almost anywhere. They cannot be exposed to extreme heat and have a shelf-life of only about six months. But nationwide, AIDS advocates are taking them to bars, gay pride events, even bathhouses to reach those who have never been tested and those at high risk.

New test sites

Their quick turnaround time also provides additional benefits in specialized health care settings such as the emergency department or delivery rooms. Some emergency departments have begun routinely asking patients whether they would agree to be tested. That’s generally done more to increase testing rates, but it also provides an additional safety measure for the staff and can help facilitate treatment decisions.

In the delivery room, HIV testing can have a much more profound implication. In 2000, more than 6,000 HIV-positive women gave birth in the U.S., and 280 to 370 of them transmitted the infection to their child. An estimated 40 percent of those children were born to mothers who did not know they were infected, according to the CDC.

When the recommended antiviral and obstetric interventions are used, however, a woman who knows of her HIV positive status now has less than a 2 percent chance of delivering an HIV-infected infant. Without intervention, that risk is about 25 percent. The rapid tests now allow women to be tested even after labor has begun.

Ideally, the CDC would like all women to be screened for HIV early in their prenatal care, when antiviral treatment is most effective. But even when administered during labor and delivery, or given to the newborn within hours after birth, it can cut the rates of transmission in half.

Women who know they are HIV positive can also take other steps to prevent transmission, such as choosing a cesarean delivery or avoiding breastfeeding.

While public health officials have long recommended that all pregnant women be tested for HIV status, rates have remained low except in states that have adopted specific regulations to promote testing.

In Illinois, after the state implemented a new law to promote screening of pregnant women, the percentage of women who knew their HIV status in the delivery room went from 72 percent in 2003 to about 95 percent in 2006. Now about three-quarters of women who do not know their HIV status consent to a rapid test before delivery.

In 2005, the rapid tests identified 26 Illinois women with previously undiagnosed HIV infections, and doctors were able to prevent infection of their newborns in 22 of the 26 cases.

As of January 1, 2006, Oregon has a new opt-out HIV testing law that requires the mother to specifically decline HIV testing. That should help providers to test all pregnant women, not just those considered at risk.

”We have to be careful because there’s a lot of what I call testing profiling going on,” McCreedy says. ”That’s really done a disservice.”

In the past year, one prenatal provider neglected to test a woman who didn’t fit the typical profile of an HIV positive patient.

”They just didn’t think this woman was at risk,” she says. That woman transmitted the virus to her newborn.

The rapid test kits are also providing the means for mass testing campaigns. Public health officials in Washington, D.C., recently announced the goal of having every district resident between the ages of 14 and 84 – some 400,000 people – know their HIV status. The district has purchased 80,000 rapid tests for that purpose.

The rapid tests also provide a golden opportunity for the tester to provide important counseling about HIV prevention in the 20 to 30 minutes while the patient waits for the results. The costs of testing are about the same as for clinical laboratory tests, although staff time is generally much less, as the tester is generally also the counselor.

”It’s got some interesting implications but I’m all for it,” McCreedy says. ”The simpler we can make this for people, (the more will get tested).”

Markian Hawryluk can be reached at 617-7814 or mhawryluk@bendbulletin.com.