On-site, rapid HIV testing with same-day results and counseling

Background: New rapid HIV antibody tests have allowed provision of results and result-specific counseling on the day of initial visit, and have the potential to increase the efficiency of HIV counseling and testing. Methods: To evaluate the use of rapid testing with same-day results in public clinics, the Single Use Diagnostic System HIV-1 rapid assay was used for a 3-month period al an anonymous testing clinic and a sexually transmitted disease (STD) clinic in Dallas, Texas. Non-reactive rapid test results were reported as HIV-negative. Reactive results were reported as 'preliminary positive'. These procedures were compared with standard testing during a baseline period, with respect to number of clients receiving results and post-test counseling, client satisfaction, counselor acceptance, cost, and effectiveness at reducing HIV risk. Results: Rapid testing resulted in an increase in the number of persons learning their serostatus: a 4% increase for uninfected and a 16% increase for infected clients al the Anonymous Testing Clinic; a 210% increase for uninfected patients and a 23% increase for infected patients at the STD clinic. Rapid testing resulted in a cost saving of US$ 11 per test in both the anonymous and STD clinics. Of those previously tested, 88% responded that they preferred the rapid test. In the year following initial HIV test, clients tested with rapid and standard procedures were equally likely to return to the clinic with a new STD (odds ratio, 0.97; 95% confidence interval, 0.7-1.4). Conclusions: Rapid, on-site HIV testing was feasible, preferred by clients, and resulted in significant: improvement in the number of persons learning their serostatus, without increasing the costs or decreasing the effectiveness of counseling and testing.