Are point-of-care HIV tests enough?

At-Home Diagnostic Testing

Are point-of-care HIV tests enough?

Mari Pack

Point-of-care tests are a useful intervention that can assist in blood glucose monitoring, test for pregnancy, and even screen for HIV. However, POC testing puts the onus of reporting a reactive HIV test on the individual test-taker. Reporting is not only necessary for individual health outcomes, but also for public health surveillance. In this article, we discuss the advantages and limitations of POC testing, as well as how at-home diagnostic tests and Ash Wellness platform better link patients to care. 

What is point-of-care testing 

Point-of-care testing is a type of rapid testing taken outside of a lab setting, often at home, and without the oversight of technicians or medical personnel. These are CLIA waived at-home tests that carry a low risk for erroneous results. An at-home COVID test is an example of a point-of-care test. 

Why point-of-care HIV testing matters

Point-of-care tests often screen for diseases and help individuals make fast decisions about medical care outside of a medical setting. When it comes to HIV, self-administered point-of-care tests are useful because they help increase awareness of an HIV infection in individuals who might not otherwise use an HIV test. Rapid POC tests such as OraQuick have been shown to help identify undiagnosed HIV infections, and are especially useful for at-risk groups like gay and bisexual men or intravenous drug users. As with any POC test, reactive HIV results should be confirmed with follow-up diagnostic tests in a laboratory setting. 

Point-of-care HIV tests are useful for rapid screening of diseases outside of a medical setting.

Where point-of-care HIV testing falls short

While an asset to the HIV ecosystem, POC testing falls short in a number of ways. Results are more likely to be influenced by human error than lab tests. A major flaw in POC tests is that individuals must seek follow-up care themselves in the event of a reactive test. Unfortunately, isolation and stigma remain barriers to initiating care for some individuals, in particular persons of color, who take POC at-home tests. This can result in delayed care for HIV positive individuals, and is linked to worse economic and health outcomes overall. Furthermore, some POC tests, including oral rapid tests, should not be used to screen for HIV infection as part of medication management for PrEP because they are less sensitive. 

To summarize, POC tests are:

  • More error-prone, without professional oversight
  • Don’t link patients to care
  • Many cannot be used for PrEP medication management 

How Ash Wellness at-home diagnostic testing platform links patients to care 

The Ash Wellness home health testing platform has many of the same benefits as POC testing with the added crucial step of linking patients to care. We are an extension of a telehealth platform and healthcare cycle, allowing physicians and other professionals to reach patients and prescribe care within the current healthcare framework.  

Our at-home diagnostic testing platform is:

  • Overseen by lab technicians and medical personnel  
  • Crucial in linking patients to care
  • Used in PrEP medication management

We use mail-in DBS (Dried Blood Spot) cards to perform fourth gen HIV tests, which can detect an infection earlier and with more accuracy. A physician or healthcare professional orders a DBS test card (or confirms a patient-requested test, in the case of public health outreach) mailed to an individual’s house. That person pricks a finger and allows blood to dry on the card in a fibrous matrix on five 13 millimeter circles. This sample is mailed to a lab where results are reviewed by a lab technician. Since samples are ordered and processed within the virtual care framework, a physician or professional can recommend next steps and prescribe care as needed. In addition to screening, this type of at-home diagnostic testing can be used to test for HIV status and changes in kidney function as part of at-home PrEP medication adherence.  

Person holding mail-in dried blood spot card for at-home testing
Mail-in Dried Blood Spot cards can be used to perform fourth gen HIV tests.

Ash Wellness platform at work in Georgia 

 In June, Ash Wellness partnered with the Fulton County Board of Health to supply DBS cards for HIV and syphilis, as well as urine tests, and throat and rectal swabs for chlamydia and gonorrhea as part of the StopHIVATL campaign. Rather than put the burden of reporting on the individual, professionals at the Board of Health contact individuals with reactive HIV test results to direct them to treatment options over the phone. No one is left alone with a reactive test result. 

Ash Wellness at-home diagnostic test platform vs. POC testing 

When it comes to HIV testing, the Ash Wellness platform lets public health departments, traditional healthcare institutions, and other outreach programs access patient populations and link them to care better than traditional point-of-care testing. When clients join the Ash Wellness platform, they can choose to onboard our popular patient or provider portals to better assist and monitor testing efforts. They can also set up linkage to care protocols that suit care team requirements.

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