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Rapid HIV test slow to catch on with doctors

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Times Staff Writer

When a rapid HIV test came on the market two years ago, prevention experts quickly predicted that it would become an important weapon in the fight against AIDS.

The 20-minute test would encourage more people to find out their status and get treatment, reducing their chances of spreading the disease, health officials said. Research has shown that people who realize they are HIV positive reduce risky behaviors by up to 70%.

But the test hasn’t lived up to its potential, because -- so far -- most physicians don’t offer it.

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“There’s still a lot of fear and misunderstanding around rapid tests among many doctors,” says Dr. Howard Grossman, president of the American Academy of HIV Medicine.

A study by the academy that is expected to be released next month estimates that only 5% of general practitioners around the country are using the accelerated tests.

The study surveyed 300 doctors in private practices in 10 states with high rates of HIV infection. A manufacturer of the rapid tests, Orasure Technologies Inc., says its sales analysis shows similar results.

Meanwhile, two separate studies released in the New England Journal of Medicine earlier this month suggest the rate of testing in the U.S. may not be high enough.

The researchers recommended that all adults get tested once and the majority of people get tested every three to five years, much as they would for diseases such as diabetes and hypertension.

The studies concluded that broader testing for HIV may be more cost effective than many common medical tests such as cancer screening or mammography.

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Grossman says that broader acceptance of the quick HIV tests in private doctors’ offices is “essential if we are going to reach everyone at risk.”

Although most public clinics and emergency rooms have slowly adopted the accelerated tests, private doctors conduct nearly half of all HIV tests each year and diagnose an estimated one-third of all new HIV cases.

According to the American Academy of HIV Medicine’s survey, many physicians who don’t offer the rapid tests are concerned about how much time it would take to train their staff to conduct the screenings or to counsel patients who discover they are HIV positive.

Doctors are required to counsel patients about risk factors associated with HIV and treatment options for those who discover they are positive before they give them an HIV test.

Another roadblock to widespread use of the tests is doctors’ fear that insurers may not reimburse them. Today, the vast majority of doctors who offer HIV tests use traditional tests and send patients to outside laboratories for blood work.

If doctors were to offer rapid tests, which cost about $10 each, they’d have to pick up the costs and hope insurers cover their bill. But with the standard tests, up to a third of patients typically don’t return to find out whether they have HIV.

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At a time when HIV infection rates are climbing in some communities, and holding stubbornly steady in others, the availability of fast and accurate testing is considered vital to controlling HIV infections.

The recent discovery in New York of a possible new strain of HIV that quickly advances to AIDS and is resistant to most available drugs adds further urgency to the need for more testing and more effective prevention strategies.

George Ma, a Los Angeles internist, says he recommends an HIV test to about 10 patients a month. But he offers only the traditional test done in a separate lab in his medical office building.

Although Ma assumes some patients either don’t get the test or fail to obtain the results, he says he doesn’t know enough about the rapid tests or their accuracy to consider using them anytime soon.

Dr. Marcy Zwelling, a Long Beach primary care specialist, also doesn’t offer the rapid tests, partially because she sees so few younger or high-risk patients. But she says cost is an issue.

“Ethically you want to offer these things, and yet the other side of the coin is that we can’t afford not to get reimbursed for them,” she says.

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The rapid HIV test can be done either with a small blood sample from a finger prick or with a newer version that uses a swab of saliva from inside the mouth.

Research shows rapid tests are 99.6% accurate and, according to the manufacturer, the tests produce a false positive result 0.2% to 1% of the time. All patients testing positive for HIV with either test must take another confirmatory test to verify the results.

The rapid tests have been heralded as a turning point in the fight against AIDS. In 2003, the federal government changed its national HIV prevention strategy in part based on the advent of the test and more effective treatments for people who test positive for the virus.

By redirecting a share of its $800-million annual HIV prevention budget to greater funding for rapid testing in public clinics and hospitals, the government hoped to give people the ability to react more quickly to a suspected AIDS exposure.

Federal officials also boosted support for community-based programs aimed at helping people who are positive reduce their risk of spreading the disease.

The Centers for Disease Control estimates that about 900,000 Americans are HIV-positive and that roughly 280,000 of them don’t know it.

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Now, as the demographics of HIV infection change, so do the traditional beliefs about who should be tested.

Rates of new infections are declining in newborns and women in general. However, rates of new infections are rising in young people, and HIV continues to disproportionally affect Hispanics and African Americans. About 10% of adults in the U.S. are tested for the virus each year.

Dr. Robert Janssen, director of the CDC’s Divisions of HIV-AIDS Prevention, says the agency is evaluating whether it should expand federal recommendations about who should be tested for the virus.

The CDC is also developing an educational campaign for private physicians about the benefits of rapid HIV tests.

The campaign, which could begin later this year, aims to convince more doctors that the tests can help them screen more of their patients and get those who are sick into treatment earlier.

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