Implementation of clinical pharmacist-conducted rapid point-of-care HIV testing

Purpose: To describe rapid point-of-care HIV counseling and testing services performed by an interdisciplinary team, including clinical pharmacists, in a healthcare setting. 

Methods: This rapid HIV testing project initially targeted African-Americans as a part of the Centers for Disease Control and Prevention African-American Testing Initiative, but was expanded in 2010 to include all populations increasing the likelihood of finding positive individuals in this urban area of high HIV prevalence as part of the Expanded Testing Initiative. Counseling and testing services were initially offered in the emergency department and mobile van in a single healthcare system, but were later expanded to the primary care clinics including an HIV clinic for more targeted testing of partners and caregivers of HIV-infected individuals. An interdisciplinary approach incorporated pharmacists as testers and counselors in the HIV clinic. After certified training at the County health department, pharmacists tested individuals using the following process: obtain consent, perform rapid point-of-care HIV fingerstick test, provide post-test counseling, obtain confirmatory specimens for reactive samples, and provide linkage to care for all confirmed HIV-infected individuals.

Results: From January 2008 through May 2012, project staff performed 17,081 voluntary rapid HIV tests with health-system patients.  Clinical pharmacists performed 165 of these tests over a one-year time period (May 2011 through May 2012). 

Conclusion: This project offers proof of principle that pharmacists effectively contribute to community health-system based HIV testing initiatives.  Pharmacists are uniquely poised to promote HIV prevention yet little description of pharmacists performing HIV testing exists.  This project was effective in reaching people at high risk of infection, identifying types of venues that would be important to target, and offering lessons to be used by other pharmacists in the design and implementation of HIV testing programs in healthcare settings.