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Getting to Zero: Home HIV Testing and Prevention Innovations

Susan Buchbinder discusses the implications of home testing for HIV and some novel prevention innovations. She provides an overview of U.S. epidemiological data showing that individuals aged 13-34 have the highest number of diagnoses. Among this group, there are high rates of infection among blacks and Latino men who have sex with men (MSM), making it clear that young men of color are a target population to address the epidemic. She lists not only individual behaviors that make young men of color at risk, such as engaging in unprotected sex and having a positive partner, but also, other more structural factors such as low CD4 counts at time of diagnosis, not knowing one's HIV status, and the presence of STIs. Access to services for young men of color was lower than for their white MSM counterparts.

In 2012, the FDA approved a rapid home test, performed using oral fluids. The rapid home test, which has a roughly 91% sensitivity, gives people the ability to test when and where they want. Following a short history of rapid tests, Dr. Buchbinder discusses the advantages and disadvantages of rapid tests performed in clinic and at home. For instance, rapid tests first proved useful because trying to get people back into a clinic to receive their HIV antibody test results remains challenging. However, as the oral test is less sensitive than a blood test, and it may not detect a recent infection, the patient still needs to have a confirmatory test. There may be problems with linking patients to care when they test at home. One program intended to address the issue of access to services is HOME--a study that will investigate why people who test at home want to know their HIV status, what support services they need, and what novel strategies can be used for linking them to health care services.

After discussing the implications of the new at-home testing technology, Dr. Buchbinder discusses some local prevention research studies and interventions such as SEX-PRO, a sexual health promotion tool intended to help patients figure out whether they are at risk of HIV transmission. Currently, a longitudinal pilot being conducted in North and South America has identified some predictors of unprotected sex, including power differentials, long-term relationships, and substance abuse. Other interventions include online tools for couples and a rectal microbicide study.