Shout Out Health

ASK THE PHARMACIST: Should I Use an At-Home HIV Test?

Q: I recently heard that you can now buy at-home HIV tests in pharmacies and drug stores. I like the idea of testing in the privacy of my own home, but how exactly do they work? Is it a good idea to do this at home rather than go to my doctor's office?"

A: Yes, you can buy at home HIV tests (such as Home Access Express HIV-1 and OraQuick) at your local pharmacy. Let me explain briefly how they work, and cover some of the issues to consider before you decide whether to use an at-home test.

Let's start with the Home Access kit, which requires a small blood sample and provides an overnight Fed-Ex mailer. Results are available via phone as soon as the next day. The cost is between $50-$75. However, in July of 2012, the FDA approved the OraQuick oral swab test for home use. The user swabs his or her mouth and then places the swab in the conrol solution. Results are available in 20 minutes. This will be available in pharmacies in October of 2012 and will cost anywhere from $17-$30. The oral test is currently only available at clinics or by organizations licensed to perform the test.

If you have a fear of clinics or doctors, the home HIV test could be one viable option. However, the oral test is 99.98% accurate when administered by a healthcare professiona. This number drops to 92% when used at home, which is probably due to user error. I would recommend using the at home test during the day when your primary care physican's office is open. If the test comes out positive, you have someone to call and guide you on what the next step is. Also, if testing alone, have friends or family that you can call if needed.

The CDC also provides a national AIDS hotline that is open 24 hours a day: (800)-CDC-INFO. The GMHC in New York City also has a hotline and can refer patients to prosepctive physicians in New York along with counseling services (800)-AIDS-NYC. Check with your state for the AIDS hotline in your area.

The home test is best for people who are already well educated on the test and HIV in general. In my professional opinion, testing at your physician's office or respective HIV organization will offer proper care and counseling. It should be noted that a negative test doesn't mean you're 100% negative. Both tests rely on HIV antibodies in the system. Antibodies typically form 3-6 months after exposure and then seroconversion. A negative test at 6 months after possible exposure would be a conclusive negative test. -- Heath P. Dobson Jr., Community Pharm, RPh 

ASK THE PHARMACIST: Confidentiality in the Pharmacy; What are Your Rights?

Q: "I was in to pick up my monthly prescriptions for HIV medications the other day. The clerk behind the counter told me my prescriptions for HIV medications had to be filled elsewhere now because it's a specialty medication. There were several people around, and she used the word "HIV" when addressing me. I don't like to disclose my status to strangers. I'm wondering if I should report this. Aren't there pharmacy rules on confidentiality? Also, have you also heard about insurance that does not cover HIV medications at a normal pharmacy?"

A: In short, it sounds like this information was exchanged near the cash register, and at the very least, this 'conversation' should have been taken to a more private area. Ideally, the pharmacy would
have contacted you by phone to review this insurance issue before you even came in. But unfortunately,
that's not the case, and this kind of scenario happens much more often than people think, and it's important to know how to handle it.

In hindsight, any member of the pharmacy staff should use extreme caution when discussing any PHI (protected health information) with a patient at the pharmacy. (PHI is any individually identifiable health information.) Because of the changes in the HIPAA (Health Insurance Portability and Accountability Act), the patient has very explicit rights when dealing with PHI. That said, the HIPAA laws are vague on information that is "overheard" by other individuals that may be standing around the patient area when information is being discussed. 

In a high traffic pharmacy, hundreds of patients cross the register daily. Some people will yell out in front of a waiting room full of strangers, “I want to pick up my Viagra and Xanax,” and not blink an eye.  Other people are much more discreet and don’t want this information known by others. 

ASK THE PHARMACIST: Is PrEP available for 'mixed' status couples?

Q: I'm HIV negative, but my boyfriend is positive. We're fully committed to each other, but navigating our sex life is a constant challenge. But I just read somewhere that there's medication that not only treats HIV, but can help greatly reduce risk of HIV infection for negative people. Am I a candidate for this medication and how do I get it? Thanks.

A: You are correct! Some recent studies have been published showing promising results with regards to antiretroviral medication helping to reduce the risk of contracting HIV. Truvada, a medication currently on the market indicated for the treatment of HIV, has demonstrated efficacy in its use in pre-exposure.

This is encouraging news for individuals such yourself that are in a "mixed" HIV status relationship. I have talked to several patients who share your concerns, and I especially hear this from HIV positive patients, who are very concerned about the possibility of passing the virus on to someone they have fallen in love with and are committed to spending their lives with.

So based on the results of the iPrEx Trial (Pre-exposure Prophylaxis Initiative) -- which you can read about in detail here -- there is reason to be encouraged. But that said, there is also reason for pause. I haven’t yet filled any prescriptions for this purpose and Truvada isn’t yet FDA indicated for this purpose.  However, clearly you would be an ideal candidate for pre-exposure therapy, being you are in a relationship with an HIV-positive person. Ultimately, this decision is up to the patient and the prescriber. I urge you to contact your medical provider and discuss your options regarding this preventive treatment. Good luck. -- Heath P. Dobson Jr., BS Pharm, RPh