Rapid versus Laboratory HIV and HCV testing for People Who Use Drugs

by Sarah Gutkind, MSPH

October 2, 2020

HIV outbreaks in Indiana, West Virginia, and Massachusetts have highlighted the need to rapidly identify and treat HIV infections among people who use drugs and their social networks in order to prevent disease transmission. Many state and local health departments have expanded their fourth generation laboratory-based HIV testing capacity that allows them to identify acute infections, and these tests are frequently employed in non-hospital settings such as drug detoxification centers. Laboratory tests can take between 3 and 5 days to process, however, leading to a delay in receipt of results or loss to follow up, and potentially continued HIV transmission. In contrast, rapid HIV antibody testing provides results within 20 minutes, although it cannot detect acute infections.

In a recent study published in the Journal of Infectious Diseases that was conducted at a drug detoxification center in Boston, CHERISH Research Affiliate Sabrina Assoumou and colleagues compared laboratory-based and rapid testing for HIV and HCV among people who use drugs in order to assess receipt of results. The single-site randomized trial found that all patients in the rapid testing arm who received their results did so in the same day. The median time to receive laboratory testing results after processing was 11 days, which included several follow up attempts to contact participants. Individuals randomized to rapid testing were more than twice as likely to receive their results within a two-week period compared with those who received laboratory-based testing (96% for HIV and 93% for HCV for rapid testing versus 42% for HIV and HCV with laboratory-based testing). Although laboratory-based testing could be helpful for HIV surveillance and to address acute HIV outbreaks, these findings highlight the distinct advantage of rapid testing in venues serving people who use drugs.