How effective are at-home HIV testing kits?

Dear Reader, 

Getting tested for the human immunodeficiency virus (HIV) can be an anxiety-producing experience. Hearing rumors about a past partner’s HIV status can certainly create additional stress. Given that you’ve potentially been exposed to HIV-positive body fluids, you may be considered “at risk” for HIV. However, the best and only way to confirm your status is to get tested. Read on to learn more about at-home testing options. 

There are three types of HIV tests which are categorized by what they test for and where sample collection and testing are done: 

• Nucleic acid tests (NATs) detect HIV’s genetic material and can measure the amount of virus in your blood. Given that NATs are more complex and often require a blood draw, they tend to be more expensive and used only if you have HIV symptoms. 
• Antigen and antibody tests detect HIV antigens (a substance on the virus that your immune system attacks) and antibodies (a substance your immune system makes to attack antigens). At-home or self-tests that allow you to collect a sample of your own blood by doing a small finger prick test tend to fall into this category. Samples are then mailed to a lab for testing, final results, and diagnosis. 
• Antibody tests detect HIV antibodies in the body. Since there are two types of HIV (HIV-1 and HIV-2), some tests will detect both. However, others may only test for HIV-1 antibodies because HIV-1 is more common and transmissible. Rapid self-tests that typically show results within 30 minutes tend to be antibody tests. These are done by either collecting a blood sample from a finger stick or taking a swab of the gums to collect oral fluid. 

HIV test accuracy is often measured by sensitivity and specificity. Sensitivity refers to the percentage of results that are positive when HIV is present (known as true positives), and specificity refers to the percentage of results that are negative when HIV isn’t present (known as true negatives). The higher the percentages, the more accurate the test. However, accuracy also depends on when you take the test. There’s a period of time post-infection called the “window period” when a test can’t detect the virus in your body, this can result in false negatives. The length of the window period may differ by test and person. It’s important to note that although tests tend to be more accurate after the window period, if you or your partner actively engage in behavior that puts you at risk for HIV infection, you shouldn’t wait to get tested. Instead, to help protect yourselves, you might consider getting tested regularly. According to the Centers for Disease Control & Prevention (CDC), if you're sexually active you should get tested at least once a year. Sexually active individuals who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ+) may consider getting tested every three to six months. Additionally, if you’re looking to minimize your risk of contracting or transmitting HIV, it may be helpful to understand additional HIV prevention strategies. 

So, what about the Home Access test you mention? The Home Access HIV-1 Test System was an accurate (greater than 99 percent sensitivity and specificity) at-home test approved by the Food and Drug Administration (FDA). However, it was discontinued in 2019.  While there are a number of at-home, self-testing brands and options available, the OraQuick In-Home HIV Test is the only FDA-approved rapid self-test that checks for HIV-1 and HIV-2 antibodies. Taking the test involves swabbing your gums with the test device, inserting it into a vial filled with solution, and waiting 20 to 40 minutes for results. While this test’s pros include speed and privacy of testing, a potential drawback may be that, due to its 92 percent sensitivity and more than 99 percent specificity, positive results often require an additional confirmatory test in a medical setting. 

If you choose to use an at-home test to confirm your status, they’re often available for purchase at pharmacies or online retailers by people 17 and older. HIV screenings in the US are typically covered by health insurance for people between the ages of 15 and 65 or those at an increased risk of contracting the virus. However, if you don’t have insurance, free or low-cost tests may be available through the local department of health (DOH). You might also consider checking out the CDC’s Get Tested resource to find options near you. And if you’re still unsure about whether self-testing is right for you, getting tested at a clinic is another option to consider. The HIV Testing Sites & Care Services Locator can be a helpful resource to use when seeking out options near you. 

Stay safe and best of luck choosing the testing options that’s right for you!