HIV self-test initiative aims to curb spread of virus in Pennsylvania

Stephanie Koons
February 26, 2021

UNIVERSITY PARK, Pa. — Two College of Education faculty members, with help from the HIV Prevention & Care Project at the University of Pittsburgh and the Pennsylvania Department of Health, have started a website that offers HIV (human immunodeficiency virus) home self-test kits to anyone in Pennsylvania. The intention of this initiative is to offer testing to people who are unaware of their status and do not have access to clinical testing.

“This is really a way to serve a particular need and not to replace in any way the better option of getting a test in a clinic,” said Liza Conyers, professor of education (rehabilitation and human services) in the College of Education Department of Educational Psychology, Counseling and Special Education.

Liza Conyers

Liza Conyers

IMAGE: Penn State

Conyers is a national expert in HIV/AIDS and employment policy; the impact of vocational rehabilitation on health and public health outcomes, social determinants of health, psychosocial and cultural aspects of disability and program evaluation of integrated vocational and HIV prevention interventions. This initiative comes directly out of her research.

“If somebody is aware of their status, they are far less likely to transmit HIV to anybody else,” said Jeremy Sandberg, project manager for Conyers’ HIV research.

Jeremy Sandberg

Jeremy Sandberg

IMAGE: Penn State

On the website, individuals who can’t find local testing, or prefer the privacy that a self-test kit provides, can request an in-home test, OraQuick, to be mailed to their homes. OraQuick, the first FDA-approved in-home test for HIV, is an oral swab test based on the same HIV test that healthcare professionals have used since 2004.

Clinic-based testing is superior to home-based testing because of greater sensitivity of lab-based tests and greatly reduced window periods (the time between the infection and detection), to name just a few reasons. While the Centers for Disease Control and Prevention (CDC) and the Pennsylvania Department of Health advise that the best way to test for HIV is at a clinic or doctor’s office, the home self-test can be a convenient option for people who are unable to obtain those services as long as exposure was at least 90 days prior to testing.

A key aspect of Conyers' research relates to gaining a better understanding of the impact of employment and vocational services on both personal and public health outcomes for individuals living with HIV. In 2018, she was appointed by Pennsylvania Gov. Tom Wolf to the State Board of Vocational Rehabilitation and she is currently the chairperson for an Ad-Hoc Committee on HIV and Employment of the statewide HIV Planning Group.

Conyers and Sandberg work on a grant called the Pennsylvania Expanded HIV Testing Initiative (PEHTI), which is a state-funded collaboration with the Pennsylvania Department of Health focused on education of HIV, hepatitis, and other sexually transmitted infections, as well as efforts to make testing available for everyone living in the commonwealth. PEHTI is focused on the implementation of the 2006 CDC guidelines for routine integration of opt-out HIV screening into a broad range of general clinical care settings. PEHTI aims to increase HIV screening among populations disproportionately affected by the HIV epidemic by providing resources to organizations who serve these groups — specifically, African American communities, men who have sex with men, and people who inject drugs.

HIV is a virus that attacks the body’s immune system. If HIV is not treated, it can lead to AIDS (acquired immunodeficiency syndrome). While there is no cure for HIV, it can be controlled through proper medical care. Early detection is paramount for controlling the transmission of HIV and for the overall health of the individual, according to Conyers and Sandberg.

An estimated 1.2 million people in the United States had HIV at the end of 2018, according to the CDC. Of those people, about 14%, or 1 in 7, did not know they had HIV.

Reaching out to the high-risk communities is complicated by the stigma that still surrounds HIV and AIDS, Conyers and Sandberg said.

“It’s a complex topic,” said Conyers. “It’s not just race, gender, or sexual orientation that makes a person more vulnerable to exposure to HIV. Social determinants of health (e.g., poverty, unemployment, homelessness) impact groups that have been historically marginalized at disproportionate rates. It is the intersection of these social determinants of health that make members of historically disenfranchised groups more vulnerable and less likely to get care.”

She added that HIV stigma is a particularly salient issue in rural communities or in cultures where there are higher rates of homophobia.

According to the CDC, HIV medications work through viral suppression — reducing the amount of HIV in the blood. Viral suppression, or an undetectable viral load, is defined as having less than 200 copies of HIV per milliliter of blood. Once someone reaches an undetectable viral load, Conyers said, they “have effectively no risk of transmitting HIV to someone else even with intimate contact.”

“So, there’s two things,” she added. “One, if you get on the medication, your own personal health outcome will be much better. And two, you reduce your risk of transmitting HIV to anybody else.”

Sandberg described the OraQuick home self-test as an oral fluid, rapid test which detects antibodies to HIV surface proteins rather than directly detecting HIV infection. He explained that the test operates in about a 90-day window period. If someone acquired HIV more than 90 days ago, that person will likely have a “reactive” result. On the other hand, if someone acquired HIV fewer than 90 days ago, there would likely not be enough antibodies to make the test results show reactive.

If an individual has a reactive result, Sandberg said, the next step would be to get a confirmatory test from a doctor in which blood would be drawn. If HIV RNA is found in the blood, “that’s a direct connection to the virus” and they would then be diagnosed.

“It’s very important that if somebody does receive a reactive test that they get it confirmed (by a doctor),” he said. “A confirmatory test would indicate if the home test result was accurate or not and reduce unnecessary anxiety for anyone who received a false positive test result. If the person is confirmed to have HIV, the doctor can provide access to life-saving medications and, when needed, can ensure that those without health insurance can get access to treatment and other support services.” 

Sandberg and Conyers acknowledged that while the COVID-19 pandemic is front and center in the news, it doesn’t diminish the need for HIV awareness. Many clinics stopped HIV testing early in the pandemic due to coronavirus concerns, they said, and the self-testing initiative was implemented with the intention of widening accessibility to HIV testing.

According to Conyers, early detection of HIV maximizes the chances for people living with HIV to manage their health like any other chronic health condition.

“It’s important to get diagnosed as early as possible, engage in treatment, seek out social support, and continue to pursue life’s dreams and goals,” she said.

(Media Contacts)

Last Updated February 26, 2021