RNA Testing VS. Rapid Testing

Is it worth the wait?

An Insight Into MSM Testing Preferences

Joshua D. O’NealMatthew R. Golden, MD, MPHJoanne D. Stekler, MD, MPH

University of Washington Department of MedicinePublic Health-Seattle & King County

Background

2003 Pooled RNA

for MSM

OraQuick Neg

but EIA Pos& Frozen OQ Pos

Real Time Testing Study

Background

Time

Window Period

Specimen Collection

Background

HIV Testing

HIV Counseling

HIV Testing Consent

Background

Methods

Methods

Eligibility

HIV Neg MSM or Transgender

Read & Speak English

Not Tested in Last 3 Months

Seeking HIV Testing

Methods

OraQuick Oral Fluids & Fingerstick UniGold Determine™*

Ab + Ag Combo

* Not Available for sale in the US

Methods

ELISA & RNA

MethodsRapid Tests

• Testing Information Provided

Survey

• Method Preference• Test Trust• ONE Test• Consent• Counseling

Rapid Test

Results

Results

Test N = 902

Concordant Rapid Positive Tests

30 (3.3%)

Discordant Rapid Tests Among HIV Pos

4 (0.4%)

Rapid Neg / EIA Pos 1 (0.1%)

Acute (EIA Neg / NAAT Pos) 5 (0.6%)

Total HIV Pos 40 (4.4%)

HIV Testing: Trust VS. Specimen Collection Method

1

2

3

4

5

1 2 3 4 5

Trus

t

Specimen Collection Method

OQ_OralFluidsOQ_FingerStickUNIGOLDDETERMINE*ELISARNA

= STD Clinic (N=267)

= Gay City (N=223)

* Not Available for sale in the US

If you could get only one HIV test today, which test would you get?

14%

9% 4%

7%

24%

11%

44%

Gay CityN= 56 OQ Oral Fluids

OQ Finger Stick

DETERMINE™*

UNIGOLD

ELISA

RNA

* Not Available for sale in the US

Should your doctor have to get your consentto test you for HIV Infection?

N = 329

N = 223

Which pre-test counseling option would you prefer?

Summary• MSM prefer less invasive specimen collection methods

• MSM trust lab based testing more than rapid HIV testing

• RNA testing was the most preferred single test

• MSM would like a provider to obtain consent for HIV testing

• MSM want pre-test counseling available with HIV testing

Limitations

• Testing information provided throughout testing session

varied by location/counselor

• Survey conducted after testing

• Not all study participants surveyed (HIV+, time restrictions)

• Representativeness: Population already seeking testing

• 4th generation test not FDA approved

Discussion

• Important to provide the most preferred types of testing

• Consider integrating RNA testing into rapid testing programs

• Once FDA approved, 4th generation rapid testing may

become a more preferable testing option

• Caution in separating both consent and counseling from HIV

testing

Acknowledgments

NIH R01 MH-86360Study ParticipantsAlere: Providing Determine™* Test KitsPublic Health-Seattle & King County HIV/STD ProgramGay City Health ProjectUW Primary Infection ClinicBernard BransonHeather D. Baldwin

* Not Available for sale in the US