Preferences for rapid point-of-care HIV testing in Nova Scotia, Canada Nathaniel M. Lewis A,B , Jacqueline C. Gahagan A and Carlye Stein A A Gender and Health Promotion Studies Unit, Health Promotion Division, School of Health and Human Performance, Dalhousie University, Halifax, NS B3H 4R2, Canada. B Corresponding author. Email: nathaniel.lewis@dal.ca Abstract. Rapid point-of-care (POC) testing for HIV has been shown to increase the uptake of testing, rates of clients receiving test results, numbers of individuals aware of their status and timely access to care for those who test positive. In addition, several studies have shown that rapid POC testing for HIV is highly acceptable to clients in a variety of clinical and community-based health care settings. Most acceptability studies conducted in North America, however, have been conducted in large, urban environments where concentrations of HIV testing sites and testing innovations are greatest. Using a survey of client preferences at a sexual health clinic in Halifax, Nova Scotia, we suggest that HIV test seekers living in a region outside of Canada’s major urban HIV epicentres find rapid POC testing highly acceptable. We compare the results of the Halifax survey with existing acceptability studies of rapid POC HIV testing in North America and suggest ways in which it might be of particular benefit to testing clients and potential clients in Nova Scotia and other regions of Canada that currently have few opportunities for anonymous or rapid testing. Overall, we found that rapid POC HIV testing was highly desirable at this study site and may serve to overcome many of the challenges associated with HIV prevention and testing outside of well-resourced metropolitan environments. Additional keywords: acceptability, access, health equity, point-of-care diagnostics. Received 30 June 2012, accepted 1 October 2012, published online 1 February 2013 Introduction In Canada, federal health agencies have suggested that increasing uptake of testing for HIV, particularly among the 26% of HIV-positive Canadians unaware of their status, is a key strategy for preventing the transmission of HIV infection. 1,2 Testing also increases the early detection of HIV, facilitates the exchange of information on HIV and sexual health, and can potentially decrease risk-taking. 3,4 Substantial evidence suggests, however, that individuals do not get tested due to fear of the testing process, anxiety over receiving a result, lack of access to testing, or stigma associated with HIV and AIDS. 3–9 In addition, tested clients may not return to receive their results due to fear of a positive result, inconvenience or time and distance constraints. 10,11 During the past two decades, innovations in HIV testing have increased the number of individuals who are aware of their HIV status and assisted in the reduction of HIV transmission. For example, anonymous HIV testing (AHT), in which individuals can be tested without providing their name or other identifying information, facilitates testing for those concerned about the stigma associated with being tested or receiving a positive result. 11,12 More recently, blood- or saliva-based rapid HIV tests received at the patient point of care (POC) have provided an alternative to the standard HIV testing process. Unlike standard HIV tests, which require central laboratory processing of a full- blood sample, about a week of processing time, and separate client visits for testing and pretest counselling, and results and post-test counselling, rapid POC HIV tests allow for testing, receipt of results, and pre- and post-test counselling within a single 20–40 min visit 13–15 Since rapid POC HIV testing collapses the process into a single visit, it increases the likelihood of each test recipient receiving a result and the speed with which they receive it. 13–20 Clients also tend to find rapid POC testing desirable because it significantly reduces the waiting time for a result and the amount of time that would be spent on two separate visits – factors that may encourage one’s initial decision to be tested. 13–20 Even at sites where rapid POC testing is not the overall preferred method of testing, it tends to be favoured by high-risk clients, such as men who have sex with men (MSM) and injection drug users. 21,22 For clients with reactive (preliminary positive) tests, the receipt of an initial result allows for timely entry into care and the uptake of strategies to reduce the transmission of infection to others. It also provides two opportunities for post-test counselling of potentially HIV-positive clients – the first following the receipt of initial result and the second following the receipt of confirmatory result gleaned from a requisite western blot laboratory test. 15,16,20,21 Rapid POC HIV testing, therefore, represents an important means of promoting sexual health by increasing testing uptake, increasing the numbers of individuals CSIRO PUBLISHING Sexual Health http://dx.doi.org/10.1071/SH12100 Journal compilation Ó CSIRO 2013 www.publish.csiro.au/journals/sh