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Stop At The Drugstore Now Includes HIV Test


The 19th International AIDS Conference begins this weekend in Washington, D.C. Some 25,000 people involved in the fight against HIV and AIDS are expected to converge on D.C. for talks. We decided to get started by having conversations about where the fight against HIV stands here in the U.S. and around the world. We'll be talking about the latest developments, including the introduction of Truvada, the first FDA-approved drug to prevent HIV infection.

Today, though, we decided to focus on testing. The Centers for Disease Control and Prevention, the CDC, estimates that more than 200,000 Americans infected with the virus don't know it. So in an effort to bring that number down, the CDC has started a pilot program to offer rapid HIV testing in drug stores and pharmacies around the country.

Joining us to talk more about this is Dr. Kevin Fenton. He is the Director of the National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention at the CDC. Dr. Fenton, welcome back. Thanks so much for talking with us once again.

KEVIN FENTON: Wonderful. Thank you for having me.

MARTIN: Why drug stores?

FENTON: You know, more than 30 percent of the U.S. population actually lives within 10 minutes drive of a retail clinic or pharmacy, and millions of Americans visit pharmacies every week. So given the need that we have in the U.S. to expand access to HIV testing, this is a wonderful opportunity for us to partner with pharmacists to expand access to HIV testing.

MARTIN: What's been the impediment to doing this so far? I mean, why now? We're more than a quarter century into this epidemic. Why only now? Has it been a technological impediment, in the sense that the technology didn't exist to do accurate, rapid testing? Or is the thinking around this different? I mean, the protocol had been that if people get testing, they get testing in an environment where they can immediately get access to services or at least some form of counseling. So what has changed?

FENTON: So that's great question. And I think over the past five years, there have been so much development in the HIV testing space, certainly in the United States and around the world. So, for example, in 2006, CDC changed its recommendations so that HIV testing would become routine for all Americans aged 13 to 64 years. Coupled with that, there have been new technological developments, so there are now new tests on the market that are highly accurate and very easy to do, using either the oral fluid or a finger prick to have a rapid diagnosis of HIV.

And then finally, we now have new partners, including pharmacies, who are providing health care access or other preventive services to the population and to communities across the country. So the partnership, the technology, as well as CDC's recommendations to increase HIV testing, have all come together for what I think is this really innovative approach to bring testing into pharmacies and to communities across the country.

MARTIN: What is the thinking about how to get people to get tested if they haven't already? I mean, as we've said before, that we are more than a quarter-century into this epidemic, and I think it is probably puzzling to many people to consider that there are that many people that the CDC estimates are living with HIV and don't know it.

So what's the thought about how even making testing more accessible and available might encourage people to get tested if they haven't already? I mean, do you see my question? How do you anticipate that - why do people still not know that they are HIV positive, and why aren't they getting tested now? What have you - what conclusions have you come to over the course of time you've been doing this work, which is quite a long time itself as well?

FENTON: So as you said, you know, there are more than a million Americans who are living with HIV, and every year we still see about 50,000 new HIV infections occurring across the country. And a key change we've seen is complacency about HIV, as people feel it's no longer a death sentence, or people don't really see some of the harrowing images which there were in the early parts of the epidemic.

And part of the issue that we're still dealing with is the stigma associated with either having an HIV test or being diagnosed with HIV, which often prevents people from getting an HIV test. Another key challenge we have is just simple access to these very effective diagnostic technologies for HIV. And so part of what we're trying to do at CDC is to expand access both through providing more free HIV testing and partnership with our state and local health departments, but also to diversify the places where people get an HIV test.

MARTIN: If you're just joining us, you're listening to TELL ME MORE from NPR News. I'm Michel Martin, and we are talking about offering HIV testing in drug stores and pharmacies. Our guest is Dr. Kevin Fenton of the Centers for Disease Control and Prevention. He's talking about new efforts to make HIV testing more widely accessible, particularly in drug stores and pharmacies.

What about the thing I asked about earlier, the counseling piece? A lot of community organizations that offer HIV testing now often make some kind of counseling mandatory. You know, the idea is that, you know, one should not receive this kind of news without somebody to talk to. So how will that part of it be addressed?

FENTON: For this initiative, one of the things we are very committed to doing is actually starting off with a pilot study, working with our pharmacy partners to look at the feasibility, the acceptability and the logistics of doing this work within the pharmacy and retail clinic setting. Based on the results, then we will have a model that could be rolled out in other pharmacies nationwide.

And part of that model will include how best to do and integrate some of the counseling and message reinforcement that we need to do with people who are testing. Remember, the vast majority of people who are going to be testing in this setting or in any other setting are going to be HIV negative. So they will need messages to reinforce positive behavior such as safer sex or safe drug injecting practices, et cetera.

For those who test HIV positive, in this pilot study we will be looking at creating links with care and treatment centers so that the pharmacists and the clinicians will be able to work together to do some of the counseling and support that will be needed.

MARTIN: I understand that there are seven sites that now offer the testing, and 17 more will be selected. Tell me, what'll happen if I come to one of these sites and I want testing? What exactly...

FENTON: What we're hoping to do is to both do the training with the pharmacists, ensuring that they are aware of how to offer the test, how to advertise the test within the pharmacy setting, what sort of location-specific adjustments need to be made so that the test can be offered and performed in a confidential manner.

And if you are a member of the public approaching one of these pharmacies, then you'll clearly see that HIV testing will be offered, and you'll be able to interact with a trained pharmacist who will offer the test, do the counseling, and of course link you to care if you're diagnosed HIV positive.

MARTIN: Even as we are speaking, the FDA, the U.S. Food and Drug Administration, approved the first over-the-counter self-administered HIV test kit to detect the presence of antibodies to the HIV virus. And you know, they're saying that the test is not definitive, it doesn't say definitively that you have or do not have HIV/AIDS, and it seems interesting that both of these innovations are occurring at the same time.

Do you have an opinion, though, about which is more desirable or efficacious, to have that testing in the home or out of the home?

FENTON: What we are very committed to doing at the CDC is ensuring that there is a diversity of strategies that people can take up. For some people, going to their physicians and having a conversation about HIV may be the thing to do. For others, they may choose to go to anonymous HIV testing clinics. For others, they may now want to purchase this over-the-counter HIV testing kit. And still for others, this access to testing through the pharmacies could be another important tool to increase access to HIV testing.

The great news is that all of these tests are going to be available. They're high-quality. They're going to be quite effective in diagnosing infection, and we're working with all of our partners to ensure that whoever gets tested have the opportunity to be linked to effective care and with counseling as needed.

So this is an exciting time for HIV testing, and it's really great that 30 years into the epidemic we have so many tools and so many methods for HIV testing.

MARTIN: Dr. Kevin Fenton is the director of the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention at the Centers for Disease Control and Prevention, and he was kind enough to join us from the CDC's studio in Atlanta, Georgia. Dr. Fenton, thank you so much for speaking with us once again.

FENTON: Thank you very much. Transcript provided by NPR, Copyright NPR.

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