HIV Testing in a Small Free Clinic

HIV infections have steadily grown in number since the virus was originally observed in 1981, with the most recent data indicating more than 36.7 million patients globally are infected. Of these, it is estimated 1.8 million were new in 2016. From the start of the HIV/AIDS epidemic through 2016, 35 million people have died from AIDS-related illnesses, with 1 million deaths coming from 2016. In the United States, many patients are unaware of their HIV status; of those aged 13-24 with HIV, only 49 percent were aware of their infection. HIV is an epidemic. Recent data indicate the rate of new HIV diagnoses are climbing in Ohio. In 2017, there were 1,019 reported new diagnoses to the Ohio Department of Health, which is up from 983 and 940 in 2016 and 2015 respectively. Of these 1,019 diagnoses, 23 percent were from Franklin County. Research has examined various vaccines and potential cures for the virus, but no such treatment currently exists. However, highly active antiretroviral therapy (HAART) is often able to suppress the infection to an extent such that transmission is near impossible. Testing for HIV is cheap, rapid, and accurate. There are three primary methods to test patients to see if they have HIV. Antibody tests detect HIV antibodies that the body produces, in either blood or saliva. The average patient takes between three and 12 weeks to produce these antibodies after being infected, leading to potential false negative results if samples are utilized during this time. Combination antibody-antigen tests detect these antibodies, as well as antigens, shortening the ‘window’ for false negative results to two to six weeks after infection. Finally, Nucleic Acid Tests (NATs) are not as commonly used, despite their one- to four-week post-infection window, due largely to cost. New Life Ministries operates a small, free clinic every Sunday morning from 7 to 9am. The organization sees anywhere from 10 to 30 patients, many of who are homeless, unemployed, or uninsured. The patient population encompasses immigrant populations, and intravenous drug users as well. During their visits, patients have access to cost-effective prescription and over-the-counter drugs, as well as physical examinations by medical students and physicians. There is some point of care testing to test blood sugar, but the site generally lacks the ability to follow-up for other diagnostic blood labs like lipid screens or metabolic panels. Given the accessibility of HIV testing supplies, and the growing patient population who would benefit from testing, we propose the inclusion of HIV testing at New Life Free Clinic, utilizing either the Antibody Test or the Combination Antibody-Antigen Test. The ability to test patients for HIV at a clinic that may be their only point-of-contact with health care is invaluable. Patients who test positive would be given information to follow up with an appropriate clinic that may be able to better serve the patient's health care needs.