National HIV Prevention Conference Atlanta, Georgia, USA — July 27 - 30, 2003

Natl HIV Prev Conf 2003 July 27-30:abstract no. M1-G0501
Lally MA, Frater SC, Dispigno MG, Shah P, Delgadillo O, Pugatch D, Flanigan TP
Brown University, Providence, RI

BACKGROUND/OBJECTIVES:: Substance users are at high risk for HIV not only because of needle sharing and "sharing of works" associated with drug use, but also because of high-risk sexual behavior. Short-term drug treatment centers provide an opportunity to interface with active substance users both for diagnosis of disease and linkage to medical care. Drug treatment centers are a site where rapid HIV testing can be used. Those undergoing detoxification may be in a vulnerable condition; false positive test results could cause additional and unnecessary distress. This study was designed to examine a fast HIV testing algorithm among women in a drug treatment center who could learn their accurate results on the day after they were tested.

METHODS: Female patients at a state-funded drug treatment center in Rhode Island were approached one morning per week. Those who agreed to participate in the study received a $25 gift certificate and were asked to complete a questionnaire about their risk behavior and prior HIV testing history. Participants were then offered HIV testing and told they would receive their results the following day. Blood was drawn and transported 30 miles to the Miriam Hospital in Providence, Rhode Island by the research nurse. ELISA tests were run that afternoon. If an ELISA was positive then it was repeated the next morning, and a Western Blot was performed as well. On that second day, participants were provided with their confirmed results and HIV risk post-test counseling.

RESULTS: One hundred seventy women were approached and 84% (142/170) agreed to participate. Those who declined most often indicated, 61% (17/28), that they were too ill to participate. When asked about behavior in the past 30 days, 56% (80/142) of the women reported having injected drugs and 50% (40/80) of those who injected reported that they had shared needles/works. Sixty-five percent (93/ 142) of the women reported being sexually active in the last thirty days. Of those who were sexually active, 37% (40/108) exchanged sex for drugs/money and 80% (86/108) used drugs or alcohol immediately before /during sex. Eighty percent (113/142) agreed to be tested for HIV. Fifty-five percent of those who declined testing (16/29) reported either recent HIV testing or known infection. Of those tested, 67% (76/113) received their results the next day, 15% (17/113) received their results at a later date and 18% (20/113) did not receive their results. One woman tested positive for HIV, and she was immediately linked to care at the Miriam Hospital.

CONCLUSIONS: It is feasible and acceptable to offer women in drug treatment HIV testing with next day results. Traditional testing methods with ELISA and Western Blot can be used to provide patients with confirmed test results in twenty-four hours. This model allows for a high percentage of high-risk inpatients at a drug treatment center to receive not only HIV testing but also confirmed test results and post-test counseling. This algorithm could be modified for use with newer rapid tests so that a positive result could be confirmed by a Western Blot within twenty-four hours.

030727
M1-G0501

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