HIV point of care testing

What is an HIV point of care test?

An HIV point of care test (POCT) is a rapid screening test for HIV intended to be performed in a clinical setting by an appropriately trained user who can interpret the test and provide suitable clinical support at the same visit. HIV POCTs, also known as rapid HIV tests, have been approved for use in Australia since 2012.

The name rapid HIV test describes the short time between collecting a sample for testing and getting a result. It does not mean the test can detect the presence of HIV soon after a potential exposure.

When to use an HIV POCT

It takes up to 12 weeks for the body to produce sufficient amounts of HIV antibodies to be detected by the HIV POCT. This is known as the window period. If you have a test within the window period, that is within 12 weeks of a potential exposure to HIV, it is recommended you have another test 12 weeks after the potential exposure as the result of a test within the window period may not be as accurate.

If your most recent potential exposure to HIV was in the previous 72 hours, speak to your care provider about post-exposure prophylaxis (PEP). PEP is a treatment that may prevent HIV transmission and is available to persons likely to have been exposed to HIV within the past 72 hours. Read the fact sheet on Post-exposure prophylaxis–HIV for more information.

How many HIV POCTs have been approved for use in Australia?

Three HIV POCTs have been approved for use in Australia:

• Abbott Determine HIV Early Detect
• AtomoRapid HIV 1&2
• OraQuick Advance HIV-1/2 (Integrated Sciences)

What is an HIV point of care test used for?

HIV POCTs are used to provide results quickly to a client following testing, however it is a preliminary screen only, the test is not used as a diagnostic test for HIV. Test results are referred to as either 'non-reactive' or 'reactive', however more familiar terms may be 'negative' or 'positive'. If the test result is reactive, a conventional blood test must also be performed and sent to a pathology laboratory to confirm the result.

Use of HIV POCTs is recommended for targeted testing of populations where a higher proportion of the population have HIV, including men who have sex with men, or the sexual partners of people from countries where HIV is more common than Australia.

How is an HIV point of care test performed?

Usually a small amount of blood is collected by finger prick. The blood is collected in a small pipette and transferred to the test device.

HIV POCTs can be done on a variety of specimens including whole blood or oral fluids. This will vary depending on the brand of HIV POCT being used.

What does an HIV point of care test detect?

Like conventional HIV tests, HIV POCTs can detect antibodies to HIV the immune system produces in response to the presence of HIV in the body. Some HIV POCTs can also identify an HIV antigen. The antigen, called p24, is a protein found within the virus. This protein can be detected in the blood earlier than HIV antibodies.

How long does it take to get a result?

The length of time required to get a result will depend on the brand of test used. All HIV POCTs can provide a result in 20 minutes or less.

How accurate is an HIV point of care test?

HIV POCTs approved for use in Australia must perform to a high level, however, HIV POCTs may not perform with the same accuracy as the 'gold standard' laboratory test. This is because HIV POCTs are often performed with samples such as blood from a finger prick or oral fluid while laboratory tests use serum or plasma derived from the blood sample collected. It is possible the HIV POCT could produce a false reactive or false non-reactive result, but this is uncommon. A false reactive result means that HIV is not present, but the test detects HIV, whilst a false non-reactive result means that even though HIV is present, the test did not detect it.

Your care provider can discuss the performance and limitations of specific HIV POCTs with you in more detail.

What happens if the test result is reactive?

If the HIV POCT is reactive, a sample of blood will be collected and sent to the laboratory to confirm the result. Collecting a sample of blood to be tested in the laboratory will confirm if the HIV POCT was a true reactive result or a false reactive result. Results from laboratory HIV tests can take up to seven days to be processed. Your care provider will be your contact while you are waiting for the laboratory test result to return. They will advise you when the result is available.

What happens if the test result is invalid?

An invalid result means the test has not worked correctly. It does not mean the test has detected HIV antibodies or antigen. An invalid result may happen for a number of reasons, such as blood clotting before it is absorbed by the test. If your test produces an invalid result the person performing the test will offer to perform another HIV POCT.

What happens if the test result is non-reactive?

If the HIV POCT produces a non-reactive result, it means the test did not detect evidence of HIV in the sample, within the capability of the test.

The person performing the HIV POCT will interpret the result in consideration of the potential exposure you have discussed with them. It is important to provide as much information as you can so the advice you receive is appropriate for you. If you have had a potential exposure within 12 weeks of the test, it is recommended you retest 12 weeks after the exposure has passed.

How often should I get tested for HIV?

How often a person should test for HIV and other sexually transmissible infections (STIs) is based on individual circumstances and potential exposures. Your healthcare provider can discuss this with you in more detail.

Where can I have an HIV point of care test?

HIV POCTs are available at most Queensland Government sexual health clinics and selected general practices and community organisations.

The following websites have up-to-date information of locations offering HIV point of care testing in Queensland:

• Sexual health services in Queensland
• Queensland Council for LGBTI Health
• RAPID HIV/STI Testing - Queensland Positive People

Can I test for HIV at home?

The Therapeutic Goods Administration (TGA) has approved the use of HIV test devices for self-testing use in Australia. The Atomo HIV Self-Test is the first and only diagnostic self-test to have met the regulatory requirements – receiving approval for inclusion in the Australian Register of Therapeutic Goods. Caution should be exercised if attempting to purchase other HIV tests for home use on the internet, as the standard, quality and reliability of these tests is not guaranteed.

HIV self-tests, like POCTs are rapid screening tests for HIV intended to be used by a person who may not have formal training in a medical field or discipline related to HIV testing. If the HIV self-test is reactive, you must see your care provider to have a sample of blood collected to be sent to the laboratory to confirm the result.

It is recognised individuals can purchase tests for personal use via the internet from overseas suppliers. However, these tests have not been evaluated by the TGA to determine their safety and performance.

Further information

For more information about HIV point of care testing, HIV and other STI testing, contact:

• your regular health care provider or general practitioner (GP)
• your local sexual health service
• Queensland Health Contact Centre (13 HEALTH) 13 43 25 84.