Will the home test for HIV screening be feasible?
When, for the first time, the possibility of making a homemade case for HIV detection available to the public was found, it met with unanimous opposition.
1. Today, the Centers for Disease Control (CDC), leading members of the health sector, "gay" activists and AIDS advocates support the idea of a home kit to detect HIV .
2. Studies that have been done on the feasibility of home tests have shown that there are no technical barriers in their use.
3. It has been possible to examine at home for more than a decade. Actually, the name "home test" tends to be misinterpreted since the person does not get immediate results, as with the homemade kits to detect the level of glucose, cholesterol, blood pressure and pregnancy. In reality, the tests are "kits to be collected" that can be purchased without a prescription at any pharmacy or through the mail. The buyer of the kit pricks his finger, deposits a drop of blood on a piece of absorbent paper, sends it by mail and then calls by phone (after a specific time) to get the results.
In the spring of 1996, the entity in charge of administering medicines and foods from the USA (FDA), approved, Confide, the first home case for the detection of HIV. The case, which was sold by a subsidiary of Johnson & Johnson, and then withdrawn from the market. The FDA then approved the Home Access HIV-1 Test System, which is manufactured by the Home Access Health Corporation in Chicago. Currently, this is the only case for home testing that has been approved by the FDA, although several other non-approved kits have been advertised in newspapers and on the Internet. The FDA warns against the use of non-approved kits, which have not been fully evaluated and that "do not have a documented history of delivering reliable results."
In what way is it different?
Traditionally, getting tested for HIV has involved having to go to the doctor or clinic, get blood, and then return for the results and receive psychological support. With the new home exam you would save two trips. This method will make it possible for people who live in rural or recondite areas of the city where clinics are scarce, with many patients or involve a long bus trip to get tested for HIV. The home test also provides privacy. Some people do not go to the doctor or clinic for fear of being seen by a neighbor, family member or friend. In a number of studies, individuals who are at risk have expressed their preference for an anonymous system by taking the test. 5 The home test offers the potential to be completely anonymous. Offering another option to get tested means taking a step towards resolving the national problem facing the HIV testing system. An alarmingly high proportion of those at risk (more than 60%) have not yet tested for HIV. 6 Obtaining HIV results becomes more and more important as the immune system needs to be strengthened and opportunistic infections kept under control. Pregnant women are encouraged to take voluntary HIV testing because studies show that when Zidovudine (AZT) is given, it can reduce the rate of mother-to-child transmission of HIV by two-thirds. 7
Are the results reliable?
Millions of tests performed to detect the presence of HIV antibodies have been made by means of a dried blood sample. 8 This type of test is quite accurate, as long as the laboratory protocol is followed closely in terms of confirming the test and the mechanisms that guarantee it. Some of the kits sent to the lab for testing may not contain the amount of blood needed to conduct the test. In these cases, the telephone counselors will have to be trained to advise the client when the results are not clear or in case they need confirmation.
Who will be tested at home?
The accessibility of the home exam can provide greater security to those people who, although the risk of HIV infection is quite remote, are looking for reassurance. If these people can no longer count on public sources to be tested, it may be that these resources are used to implement more interventions aimed at those at greater risk. 9 The sales of the kits for home testing have not been as numerous as expected according to the results obtained from surveys about intentions about home tests. In the first year of the sale, Home Access Health sold 152,044 cases; 148,039 people called to get their results. The index of seropositive results was 0.9%. 10 In addition to denial and other psychological barriers, many find the retail cost of $ 30- $ 40 per case to be impossible. The companies that manufacture the home test kits are working with several public and community health agencies, selling the cases to the elderly so that they can use them in their prevention campaigns.
What is the concern?
One of the concerns is the appropriateness of psychological support. In a clinic or doctor's office, the results are usually delivered in person. If the patient is extremely overwhelmed by the news, there is a present expert who can help. Companies that sell the home kit will also make counselors available, but they will be miles away on the telephone line. As one of those who criticize the home exam explained, "the 1-800 number can not hug you when you cry." 11 For some, the remoteness and anonymity of phone counseling allows them to more easily reveal feelings of pain or pain. embarrassing information In addition, there is already a long tradition of intervening by means of the telephone in crisis and in the prevention of suicide. The proposal to provide psychological support over the phone should be compared with experiences that currently occur when they are tested for HIV. For many, counseling is neither adequate nor does it exist. According to the data provided by the National Health Interview Study, one third of those who were tested for HIV obtained the results by mail (16%) or by telephone (17%). 12 In public places, about 2.5 million annual tests are done. In 1995, 25% of the people who had positive results and 33% of the people who had negative results, failed to return for their results. 13 By contrast, 97.4% of people who bought home test kits called to get their results. 10 Another concern is the potential for abuse to which the home case could lend itself. Some fear that employers, family members or health care providers can send blood samples without the person's consent. Although there are already laws that protect in case they are made without the permission of the person either because of discrimination or because they are HIV positive. These statutes need to be enforced; new protection laws should be created as experience with the home exam is gained.
What are the limitations?
A positive test result does not guarantee access to the necessary health care. As the National AIDS Commission wrote, "It is very cruel that many of the poor believe that they will gain access to the health system and social services through an HIV positive diagnosis." 14 However, this should not prevent the people look for how to get tested. "The lack of good health services and social services for people infected with HIV is an argument to increase them, not to reduce them." 15 Getting tested for HIV does not necessarily mean the end. The most important challenge is to achieve safe access to health care services and continuous psychological support for all those who take the test. If they turn out to be HIV positive, they should receive the necessary medical care to stay healthy, and if the result is negative they should receive the necessary support to stay negative.
