Public Health Rationale for rapid Nucleic Acid or p24 Antigen Tests for HIV

Rapid diagnostic tests that might be capable of detecting human immunodeficiency virus (HIV) antigens or nucleic acids represent the possibility of merging 2 key advancements in HIV testing: rapid testing and detection of acute HIV infection. In this article, we review the public health goals of rapid HIV testing and acute HIV testing and explore how rapid tests to directly detect HIV antigens or nucleic acids might alter current approaches to HIV case identification in clinical and public health screening settings. We discuss the specific types of HIV screening programs and settings in which direct viral rapid testing would offer an important advantage. Finally, we suggest priorities in operations research that must be achieved to pave the way for the future introduction of direct rapid viral testing technologies in the HIV testing marketplace. Human immunodeficiency virus (HIV) diagnostics are in a period of transition. The Centers for Disease Con-trol and Prevention (CDC) currently promotes the widespread use of simple rapid HIV tests [1], and some public health agencies have instituted and are expand-ing programs that use very sensitive assays (eg, antigen immunoassays or complex nucleic acid amplification assays) [2, 3]. These technologies address different im-portant deficiencies in the existing approach to HIV diagnostic testing. Although these tests also pose dis-tinct challenges, their use represents the future of HIV screening in the United States and abroad. In this article, we address the following 3 issues: (1) what gaps these innovations in HIV testing attempt to address, (2) how the use of rapid tests and tests capable of detecting HIV antigens or nucleic acids can be tar-Potential conflicts of interest: none reported