Should HIV Home-Testing Kits Be Used?

There’s a very interesting article by Sheldon Campbell and Roger Klein in the October edition of The Journal of Clinical Microbiology about the pros and cons of home-testing for HIV. At first glance, this would only seem to be a good thing: after all, we use home pregnancy testing kits, so why not an HIV kit?
Well, like everything, there is good and bad. First, the potential bad outcomes:

(italics mine)

In the worst case, a rapid HIV test would be approved, but the real-world accuracy in the hands of intended users would be less than intended. The test would be expensive and heavily and widely marketed beyond high-risk groups. False-positive tests would be frequent in low-risk populations where inappropriate self-testing would become common. In high-risk populations, the test would instill a false sense of security, exacerbated by false-negative results and a poor understanding of the limitations of the test. Transmission would increase in some groups, especially young people during the highly infectious window period*. Positive and negative tests could be misinterpreted, and persons needing care may lack the resources to find it. Other testing resources and programs might be harmed by competition with the OTC test, and access for underserved populations overall may be harmed and not improved.

On the other hand, there is a best case scenario too:

In the best case, a rapid HIV test that is economical, selectively marketed to at-risk persons, and accurate in untrained hands would be approved. Persons who would otherwise go untested would self-test, and most who are infected would be directed to early care and prevention resources. Persons engaged in risky behavior would utilize self-testing to reduce their risk of acquiring HIV. Overall, there might be a reduction in HIV transmission and an increase in the early diagnosis and treatment of HIV disease.

Just something to keep an eye on, particularly since the authors claim–and I think they’re correct–that even assessing the outcomes of home-testing will be very difficult.

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