Will the Oraquick result still be correct?

Up to the blood

Issue 2 - 2013

Testing yourself for HIV - is that even possible? And how does it feel? An AIDS aid worker wanted to know. Because although there are some arguments against it, he found the idea appealing: finding out what's going on quickly and easily at the kitchen table. Self-experimenting the HIV home test.
By Max Mohnwitz *

I actually wanted to go to the Tropical Institute at the end of April. In my experience, the HIV test is the most straightforward there: You don't need to make an appointment, you get your turn quickly, hardly any questions are asked and you remain completely anonymous. Since I am familiar with HIV, I am happy to forego detailed advice. You will be given a handwritten number and blood will be drawn from the vein. A few days later you pay 12 euros and get the result. An HIV test can be that simple.

But couldn't it be even easier? No driving to the other end of town, two appointments less, no contact with doctors and nurses? Instead, certainty after half an hour at the kitchen table? I confess: that sounds tempting! That's why I recently decided: I'll try the HIV home test.

You even have to take a blood sample Doctors sometimes practice for a long time

It's no secret: home tests may not be sold to end users in Germany, but various providers send the tests from abroad to Germany. Deutsche AIDS-Hilfe advises against such offers, however, because the quality of these test kits is not guaranteed.

Fortunately, I have a reputable source. A doctor I trust gives me three different test sets, approved for professional use in Germany, each in duplicate. If so, then already. One of the tests will work on oral fluid and the other two will work on blood. The doctor I trust, however, weighs his head and warns: “Drawing blood from the fingertip is not easy. Doctors also have to practice this first. Some even prefer to take blood from the vein because it's easier. "

I let him talk and insist on taking the blood tests too. If I test the home test, then all the variants. And if a test is positive, I still have a few procedures in reserve to check the result. After all, such a test can also be falsely positive. “I just test myself until I get the right result,” I jokingly say to a colleague.

Meanwhile I feel a bit queasy: Can I do it alone? Do I even manage to poke my finger? Is the result reliable? What if I should be positive? Well, I had this concern the last time I went to the Tropical Institute. And if it were, I'd rather be alone with this message. Otherwise I might have to give courage to a complete stranger who finds it difficult to deliver bad news. I've experienced something like this before (“But, Frau Doktor, such syphilis is not a broken leg!”).

Left: The Oraquick is the simplest test and works with saliva; Middle: This test works with blood. Right: blood flows - just not into the tube

It's a slaughter

The time has come on a Friday lunchtime. I lock the cats out of the kitchen, pour a jute bag full of shrink-wrapped test sets, individually wrapped alcohol swabs and finger pricks on the kitchen table and immerse myself in the instructions.

The Oraquick test, which is already approved as a home test in the USA, takes 20 minutes to read the result. It works with a swab from the lining of the mouth. I'll do that first, I think, then I can do one or two blood tests while I'm waiting.

The instructions are a little tricky. Each step is described in great detail, and knowing that application errors can lead to incorrect results, I read everything three times. I'm nervous, but more relaxed than before the blood sample was taken at the Tropical Institute.

And off you go: I cover the workplace with an absorbent pad, as the instructions suggest. Then I turn on a vial of a solution and put it in a small plastic stand. I take a small plastic spatula from a separate compartment in the test packaging and run it along the gums above and below the teeth. Then the spatula comes upside down into the tube.

The result will soon appear in a display field. One line means negative, two lines "reactive", ie positive. But first, as announced in the instructions, the entire display field turns pink. Everything is going as planned. I have time for the blood test now.

Let's anticipate: It's a slaughter.

The position of the German AIDS Aid

Deutsche AIDS-Hilfe does not advocate introducing home tests in Germany as well. For the strongest argument of the home test proponents, that the home test would lead people to the test who otherwise could not be reached, there is no scientific evidence. At the same time, there are indications that the home test could also harm. In any case, it is fraught with considerable risks from both an individual and an epidemiological point of view. We will continue to point out these risks.

At the same time, however, Deutsche AIDS-Hilfe takes into account the fact that some people already carry out HIV tests themselves; To do this, they resort to offers from the Internet. We respect this decision and will in future support people who decide to take such a test with more information on how to perform it correctly and how to interpret the results.

A detailed position paper of the German AIDS Help can be found at http://aidshilfe.de/de/aktuelles/mektiven/hiv-test-fuer-den-hausgebrauch

The new HIV report from Deutsche AIDS-Hilfe revolves around studies on the chances and risks of home tests, describes the available test procedures and reports on models of home tests with expert assistance that are practiced in England and Malawi: www.hivreport.de

Deutsche AIDS-Hilfe answers frequently asked questions on the subject in a new FAQ area: http://www.aidshilfe.de/de/faq/faqs-zum-hiv-heimtest

The pipette has not read the instructions

Although needle phobic, I manage to sting myself. Rub your finger a little to attract blood, then disinfect with a cloth - no problem. Then it gets a bit uncomfortable because you should keep your hand below hip height - suboptimal working height. After all: The pricks are built in such a way that you don't have to push the needle into the fingertip with your own force, which might have resulted in me hesitating for minutes. You trigger a mechanism at the push of a button, which then shoots the needle into the meat. What a service.

I'm bleeding! Now all I have to do is hold a very thin pipette on it. It will automatically draw in exactly the right amount of blood up to a mark on the tube. Says the instructions. The pipette apparently has not read the instructions. She doesn't suck. Under no circumstances should you press on the small bellows at the end. So I hold the pipette a little at an angle. Maybe blood is running in? But the blood just runs down your finger. And already curdles. Result: a sticky, bloody fingertip, an almost empty tube.

New prick, new tip, new pipette, new luck. Think. Again, not enough blood flows into the tube. I push harder on my finger to get more blood. I know you should just “milk” carefully, at the bottom of the fingertip, not around the puncture. Otherwise, tissue fluid could thin the blood and falsify the test result. In my case, however, it doesn't really matter. Because none of it runs into the tube. Sticky-bloody fingertip number 2.

As I ponder my failure, I suddenly get frightened. I completely forgot to keep an eye on the Oraquick! What if it shows two lines and I can't do any more tests? A look at the clock tells me that the Tropical Institute has already closed. I would have to wait until Monday. Fortunately, the Oraquick only shows one line. I relax a little and take the third attempt with the last available finger prick.

Sticky, bloody fingertip

And fail miserably again. This time I'm getting really angry. With the hectic pace of despair, I squeeze all over my front phalanx. This is the last attempt, it just has to work! But the blood does not run into the tube. Bloody sticky fingertip, the third.

Okay, I give up. My trusted doctor was right: the blood is not without it. Or I'm too stupid.

Fortunately, my Oraquick stuck to one line. However, I know that this test procedure is not particularly reliable. Application errors make the result even more uncertain. The test misses seven out of 100 HIV infections when self-administered, and still two among professionals. Maybe I did everything wrong here too? Maybe my negative Oraquick is worthless? Good thing I have another one. It's really easy, I don't even need the instructions anymore. Again there is only one line. Uff.

And yet my personal conclusion is: An uncertain Oraquick result is not enough for me. I'll be going back to the Tropical Institute soon. I prefer to have people who have learned how to draw blood.

* The author's name is really different

Issue 2 - 2013


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