{"id":2946,"date":"2012-07-05T10:16:24","date_gmt":"2012-07-05T14:16:24","guid":{"rendered":"http:\/\/blogs.nejm.org\/?p=2946"},"modified":"2015-06-04T15:14:22","modified_gmt":"2015-06-04T19:14:22","slug":"home-hiv-test-big-news-but-why-and-what-impact-will-it-have","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/home-hiv-test-big-news-but-why-and-what-impact-will-it-have\/2012\/07\/05\/","title":{"rendered":"Home HIV Test Big News &#8212; But Why? And What Impact Will It Have?"},"content":{"rendered":"<p><a href=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2012\/07\/bignews1.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignright  wp-image-2952\" title=\"bignews\" src=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2012\/07\/bignews1.jpg\" alt=\"\" width=\"132\" height=\"176\" \/><\/a>The recent <a href=\"http:\/\/www.fda.gov\/NewsEvents\/Newsroom\/PressAnnouncements\/ucm310542.htm\" target=\"_blank\">FDA approval of a home HIV antibody test<\/a>\u00a0(OraQuick In-Home HIV Test)\u00a0was covered just about everywhere. It&#8217;s an oral swab test, takes 20-40 minutes, and will be available over-the-counter.<\/p>\n<p>How big a news story was it?<\/p>\n<ul>\n<li><a href=\"https:\/\/news.google.com\/news\/rtc?pz=1&amp;cf=all&amp;ncl=dqiyKRc3R3dcw7M-zLoZC2d98TJjM\" target=\"_blank\">Several hundred sources<\/a>\u00a0featured it on the day of the announcement, and the total count is now well over a thousand<\/li>\n<li>It grabbed the coveted\u00a0<a href=\"http:\/\/www.nytimes.com\/2012\/07\/04\/health\/oraquick-at-home-hiv-test-wins-fda-approval.html?_r=1&amp;src=me&amp;ref=health\" target=\"_blank\">far-right column of the front page of the <em>New York Times<\/em><\/a>\u00a0&#8212; not much HIV or ID-related information makes that spot these days<\/li>\n<li>It&#8217;s been picked up by numerous international media outlets;\u00a0Canadian HIV specialists are\u00a0<a href=\"http:\/\/www.montrealgazette.com\/health\/Bring+home+test+Canada+experts\/6886433\/story.html\" target=\"_blank\">calling for approval of the test in their country as well<\/a><\/li>\n<li>Naturally, our <em><a href=\"http:\/\/firstwatch.jwatch.org\/cgi\/content\/short\/2012\/705\/1?rss=1&amp;utm_source=feedburner&amp;utm_medium=feed&amp;utm_campaign=Feed%3A+PhysiciansFirstWatch+%28Physician%27s+First+Watch%3A+Current+Issue%29&amp;promo=OFWBJWGT\" target=\"_blank\">First Watch<\/a><\/em> service made the story #1 today<\/li>\n<\/ul>\n<p>Note that the coverage of the approval has been overwhelmingly favorable.<\/p>\n<p>I&#8217;m glad that the approval has raised the importance of HIV testing in the public&#8217;s eye, but confess I was a bit surprised by just what a huge news story this has become. Furthermore, relatively few have questioned how useful this test will be. After all, another home HIV test was approved for use in 1996, and its impact has been limited.<\/p>\n<p>(Some believe that this is because it&#8217;s relatively costly and is not really a true home test &#8212; it requires a fingerstick at home, then mailing the specimen into a central lab.)<\/p>\n<p>It&#8217;s significant that something similar to this recently approved true home test was initially under review way back in 2005. \u00a0Shortly thereafter, my inimitable colleagues Rochelle Walensky and David Paltiel <a href=\"http:\/\/annals.org\/article.aspx?volume=145&amp;page=459\" target=\"_blank\">published an opinion piece<\/a>\u00a0in the <em>Annals of Internal Medicine<\/em> entitled, &#8220;Rapid HIV Testing at Home: Does It Solve a Problem or Create One?&#8221;<\/p>\n<p>The provocative title says it all: \u00a0They argued\u00a0that home testing, while helping to increase the number of tests and decrease stigma, would have a negligible effect on identifying more people with undiagnosed HIV infection &#8212; all while creating additional problems due to the inaccuracy of the test:<\/p>\n<blockquote><p>Home HIV testing will attract a predominantly affluent clientele, composed disproportionately of HIV-uninfected, \u201cworried well\u201d persons and very recently infected persons with undetectable disease [due to the window period before seroconversion]. This will have the perverse effect of increasing the proportion of false-positive and false-negative results, while making little appreciable dent in the size of the undetected HIV pool.<\/p><\/blockquote>\n<p>So hooray for the normalizing of the HIV test.<\/p>\n<p>But whether the home test will actually do much to identify those at greatest risk remains to be seen.<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>The recent FDA approval of a home HIV antibody test\u00a0(OraQuick In-Home HIV Test)\u00a0was covered just about everywhere. It&#8217;s an oral swab test, takes 20-40 minutes, and will be available over-the-counter. How big a news story was it? Several hundred sources\u00a0featured it on the day of the announcement, and the total count is now well over [&hellip;]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3,8,9],"tags":[423,447,680],"class_list":["post-2946","post","type-post","status-publish","format-standard","hentry","category-health-care","category-patient-care","category-policy","tag-hiv","tag-hiv-testing","tag-oraquick"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/2946","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/comments?post=2946"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/2946\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/media?parent=2946"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/categories?post=2946"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/tags?post=2946"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}