In-Home HIV Testing with OraQuick

5/09/2013 05:08:00 PM
Disclaimer: I have not communicated with and have no relationship with the makers of OraQuick, nor was I compensated in anyway for this post. 
I have written about HIV testing here and here. In both cases I argued in favor of universal adult HIV testing, regardless of risk factors. To prove I also walk the walk, I decided to blog about my experience with the recently-approved in-home HIV test called OraQuick, which is a test that you can buy online or in a store and uses a sample of saliva to test for markers indicative of HIV. This is my first experience with in-home testing. Unlike previous in-home HIV tests, which required you mail the sample to a company for testing, OraQuick will give you results right on the spot in 20 minutes.

The first task, of course, was to find a place to buy the testing kit. I didn't want to order it online, so I looked for it while I was at the store. Their website here names a few stores that supposedly sell the product; however, while Walmart was on the list, I looked there and could not find it. So I went to Rite Aid instead.

It was not hard to find OraQuick at Rite Aid. It was on the top shelf in a section immediately next to the condoms among other sexual health products. The price was \$39.99--slightly less than the national average for in-hospital testing (which was \$48.07), about equal to the cost of two flu vaccines. I noticed that there was only one kit on the shelf--not sure if that means that not many people are buying so they didn't stock very many, or if that means plenty of people are buying so they are almost out of stock. At anyrate, I grabbed it and headed to the register. The cashier was very talkative with the guy in line in front of me, but there was a marked change in attitude when she saw what I planned to buy. Though she struggled act normal, I certainly felt like there was a stigma about the whole thing. When she rang up the testing kit, for some reason she needed to enter my birthdate into the computer--in retrospect I'd like to know why, was that a store policy, or the law? And since she didn't check an ID, what meaning could it possible have?

The packaging on the testing kit could be improved. Having done academic research on HIV and testing, I was already familiar with the product and knew what to look for. I had also made deliberate plans to go looking for it in the store. Although the rather ambiguous brand name "OraQuick" was instantly recognizable, someone who was unfamiliar with the brand would probably not have noticed the much less readable, smaller print where it said "IN-HOME HIV TEST." I would suggest they make this much more prominent on the packaging, and maybe that will help remind and encourage regular condom-shoppers to get tested. As it is, I doubt they even notice the HIV tests siting there on the shelf.

On the back of the package it lists off a set of "risk events" that mean you should get tested:
  • Sex (vaginal, oral, or anal) with multiple sex partners
  • Sex with someone who is HIV positive or whose HIV status you don’t know
  • Sex between a man and another man
  • Using illegal injected drugs or steroids
  • Shared needles or syringes
  • Exchanged sex for money
  • Having been diagnosed or treated for hepatitis, tuberculosis or a sexually transmitted disease like syphilis
I'm not too happy with this list. For one thing, I think it is deceptive. At first glance you'd get the impression that a woman currently involved with only one sexual partner shouldn't get tested. But pay close attention to the second bullet--even if your sexual partner has been tested, you can't be sure they haven't been infected since the test, so the correct reading of this is that literally everyone who has had sex should get tested. They should just say so. My second problem with this list is that it is just a list of marginalized and stigmatized groups, and presenting the testing recommendations in this manner will only discourage people from getting tested for fear of being stigmatized. They should, by all means, educate people on the factors that elevate risk for HIV, but the recommendation should be that all adults get tested regularly. As an aside, it says you should not use the test if you are 16 or younger. Given that the CDC recommends tests for everyone 13 and older, and the USPSTF recommends everyone 15 and up, I'd like to know why 13 to 16 year olds shouldn't use OraQuick--is it inaccurate for these demographics?

Inside the cardboard box it came in, there is a second plastic box that contains the actual testing kit--they could streamline the packaging a lot. As I flip open the plastic container, I'm greeted with "Congratulations on you personal decision to test yourself for HIV!" Why thank you.

Inside, there is a test tube with a clear fluid in the bottom, a test stick that has a foam pad on one end and an indicator with a couple markings next to it on the other end, a short dark green wooden pencil, a couple booklets, and a self-sealing opaque bag meant to ensure privacy when you throw everything away afterwards. I'm advised to read the booklet titled "HIV, Testing & Me" before proceeding. One interesting factoid it reveals is that in a clinical trial, 8 out of 96 HIV-infected people actually tested negative using OraQuick. So this isn't exactly a highly reliable test. By contrast of the 4903 non-infected people in the study, only one got a positive test using OraQuick--it seems to me that the test is poorly calibrated, since ideally we'd want it to skew towards more false positives and fewer false negatives. Additionally the booklet contains a phone number you can call for advice and support, and to answer any questions.

After reading the booklet I read the next set of instructions--not to eat or drink or use any oral care products for 30 minutes prior to testing. Oops. We'll reconvene in half an hour...

To actually do the test, I swipe the pad on the test stick along by top gums and then along my bottom gums, as instructed, and then place the test stick into the test tube. Time: 3:18 pm. There is a compartment in the plastic container of the test kit to hold the test tube and test stick while you wait 20 minutes for it to test. I'm advised not to check the results before 20 minutes, and no later than 40 minutes, after which the test becomes inaccurate. There are two marks on the test stick next to the indicator, one labeled C and the other labeled T. I'm told that if, after 20 minutes, there is no red line on the indicator next to the C, then the test did not work. If there is a red line, even if it only shows up as a faint mark, next to the T, then it means that it tested positive for HIV.

Time 3:38 pm. It has been 20 minutes, so I'm ready to check the results. There is a red line next to the C, no mark of any kind next to the T. I'm HIV negative.

Now that I've done it, so should you! Go get tested folks!

Update: A couple of what appear to be African scammers selling fake treatments for the deadly HIV virus have been trolling my comments section. This is perhaps the saddest scam I've ever seen. It is also a criminal act in the United States, as they are engaging in medical malpractice, without a medical license, with deadly outcomes. As a result, the comments section on this post is closed. Tweet me instead @hyperplanes.
Anonymous 8/24/2013 11:08:00 AM
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