Implementation of Rapid HIV Test in California Slower Than Expected

Nearly one year after the FDA approved OraSure Technologies' OraQuick HIV test, fewer than a dozen sites in California are offering the test, the Los Angeles Times reports (Costello, Los Angeles Times, 10/29). In February, President Bush announced a plan to expand the availability of the rapid test, which offers results that are 99.6% accurate within 20 minutes, to more than 100,000 doctors' offices and public health clinics nationwide (Kaiser Daily HIV/AIDS Report, 10/1). The rapid test is a "cornerstone" of the CDC's new HIV prevention strategy, according to the Times. The agency estimates that up to one-quarter of the approximately one million people living with HIV in the United States are not aware they are infected. The slow implementation of the test has "frustrat[ed]" both doctors and patients, because up to one-third of the people who undergo traditional HIV testing fail to return for their results, meaning they could unknowingly pass the virus on to other people, according to the Times. Advocates attribute the slow implementation of the test to the state's strict testing guidelines and to confusion over how to implement new testing procedures. California has the strictest testing regulations in the country, according to the Times. In addition to complying with a federal guideline requiring sites offering blood tests outside of traditional lab settings to apply for a federal waiver, the state also requires test administrators to have at least a high school diploma and undergo more extensive training than the federal government requires. However, many of the people who are expected to administer the test are HIV counselors who have had little or no prior experience administering blood tests. "It's been a little confusing figuring out how this test fits in with our current system and all the rules that surround it," Deanna Sykes, who has overseen implementation of the test for the state's Office of AIDS, said.

Delays
A state pilot program, which was to have been introduced at 11 sites in May, has begun at only four locations because many of the testing sites do not have proper measures in place to ensure the test's safety and accuracy, the Times reports. In addition, a recent Los Angeles County proposal for 26 testing sites was delayed for several weeks because state Department of Health Services officials were unsure whether the county's application, which included all 26 sites on the same application, was valid. Although state officials approved the application after checking with federal officials, it could still be "months" before counselors at the 26 sites are trained to administer the test, according to the Times. State officials say they are trying to process waivers faster and offer training seminars in order to make the test available at as many as 700 sites statewide by next summer. In addition, the state Legislature early next year is expected to consider a bill that would condense some of the training into one day to reduce training costs (Los Angeles Times, 10/29).