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The OraQuick Rapid HIV-1 Antibody Test (top left) is performed in three simple steps, using whole blood. A blood sample (top right) is collected using the provided loop. (Bottom right) Place the developer solution vial into the provided test stand. Then immerse the loop in the vial solution and stir to mix. (Bottom left) The accurate results are available in 20 minutes.

Waiting two weeks to find out if you’ve been exposed to HIV is a high-anxiety ordeal, especially for health care workers stuck by a needle or splashed with a patient’s blood.

“There’s nothing like that wait,” said Adele Webb, executive director of the Association of Nurses in AIDS Care, referring to the time it takes for traditional HIV test results to be processed in a lab.

Webb, RN, PhD, ACRN, FAAN, understands personally what that wait feels like: An ED patient who had been raped bit Webb in 1995, and the nurse had to be tested. But that was before the advent of a new HIV test that can deliver results in 20 to 40 minutes.

A newly approved oral quick test not only produces results quickly, but also lowers the health care worker’s risk of occupational HIV exposure by eliminating the need to draw blood.

Public health advocates are hoping the fast and easy tests will move more U.S. adults to get tested, a goal that Susan Shewmaker, RN, MA, thinks nurses need to take a more active role in achieving.

“Nurses are often one of the first caregivers a patient sees,” said Shewmaker, a medical training specialist at the Centers for Disease Control and Prevention’s National Center for HIV, STD and TB Prevention. “They are on the frontlines of care. They spend more time with patients than physicians do.”

Shewmaker believes that nurses can take the lead in persuading patients to undergo HIV testing as regularly as they would screening for other life-threatening diseases. Nurses need to offer the test to all patients in areas with a high prevalence of HIV infections, said Shewmaker, and to all patients who have high-risk behaviors.

“Nurses need to take the time to ask about a person’s sexual history and to offer prevention information and test referrals,” she said.

Convenient and accurate

The CDC’s Advancing HIV Prevention initiative, launched in 2003, has made increased testing a national priority. The initiative calls for testing to be incorporated into routine medical care and to be delivered in more nontraditional settings like community centers and mobile health units.

Less than half of adults aged 18 to 64 have ever had an HIV test, according to the CDC. The agency estimates that one-fourth of the 850,000 to 900,000 HIV-infected people in the United States do not know they are infected. That means they are not receiving the treatment that can prolong their lives, and they may be unknowingly infecting others. About 40,000 new HIV cases are reported each year in the United States, and that number has held steady for the last few years despite massive efforts in prevention education.

Even when people do get tested, many fail to return to the testing site to learn their results. At CDC-funded sites, a startling 31% of people tested for HIV don’t return for their follow-up appointment. But the new one-stop approach to HIV testing may change that pattern.

The OraQuick Rapid HIV-1 Antibody Test, developed by OraSure Technologies of Bethlehem, Pa., was approved in November 2002 to detect the HIV antibody in a blood sample taken with a finger stick.

In March, the Food and Drug Administration approved the same rapid-results test for use with an oral fluid sample. Both uses of the OraQuick test deliver results in as little as 20 minutes with more than 99% accuracy.

The oral fluid test is given by swabbing the outer gums of the person being tested with a device that contains an absorbent pad at the end. After the gums have been swabbed, the tester inserts the device into a vial containing a solution. If HIV antibodies are present, a small window on the device displays two reddish-purple lines.

This preliminary positive result has to be confirmed with a blood test, and if someone tests negative but had recently engaged in high-risk behaviors, such as sharing needles or having unprotected sex, counselors recommend they be tested again in three months.

HIV tests detect antibodies produced by the human immune system when someone has been exposed to HIV. Most people develop antibodies within two to eight weeks, and by three months after being exposed to infection, 97% of the population will develop antibodies. In some people, it takes up to six months to develop detectable antibodies.

The FDA has approved two other rapid-results blood tests: Reveal Rapid HIV-1 Antibody Test by MedMira Laboratories and the Uni-Gold Recombigen HIV Test by Trinity Biotech. Both the OraQuick and the Uni-Gold Recombigen tests have been deemed waived tests under the provisions of the Clinical Laboratory Improvement Amendments, which established quality standards for laboratory testing. CLIA-waived tests are determined easy to use and can be given in clinical and nonclinical settings such as outreach centers and health fairs.

“This really is going to open the way for a lot of people to be tested,” Shewmaker said.