OraQuick ADVANCE Rapid HIV-1/2 Antibody Test

A Dentist's Role in HIV Testing

Photo Courtesy of OraSure Technologies

The world-wide numbers are frightening: An estimated 36 million people are infected with HIV/AIDS. Every 9 1/2 minutes, an American is infected with the HIV virus. Estimates also show that 20% of the 1 million people infected with the disease are unaware they are infected. What most people don't understand is the importance of an early diagnosis. HIV/AIDS expert Mark Cichocki, R.N., states that "The importance of early diagnosis of HIV can't be overstated.

Two-plus decades of HIV and AIDS research has proven that the earlier HIV is diagnosed, the better the prognosis and the likelihood of a long, healthy life."

The unfortunate stigma attached to being HIV positive often interferes with common sense, and ultimately instills a fear that prevents millions of people from obtaining regular HIV testing. The fear of needles and blood work, along with the agonizing wait for the test results, possibly inhibits the importance for the test, and often prevents or delays diagnosis.

If HIV testing was obtainable without the need for a blood sample, would more people be willing to be tested for HIV? According to Ron Ticho, Vice President - Corporate Communications, OraSure Technologies, the OraQuick ADVANCE HIV Test is the first and only FDA-approved HIV test, for use with both oral fluid and blood specimens. "The rapid oral fluid process, in particular, is very fast and easy.

The individual simply swabs the testing device, just one time, around the outer upper and lower gums. The testing device is then placed into a vial containing a developer solution and results can be visually read in just 20 minutes," explains Ticho. With results available in just 20 minutes, and an accuracy greater than 99, testing for HIV has become so much easier than most people are prepared to believe.

HIV Testing and Your Dentist

Dr. Catrise Austin, a dentist in New York City, recognized the importance of HIV testing and the knowledge that comes with a diagnosis of HIV. She introduced the OraQuick ADVANCE Rapid HIV-1/2 Antibody test to her dental practice, VIP Smiles, and was happy to answer my questions about a dentists role in HIV testing.

What made you choose to introduce rapid oral HIV testing into your dental practice?

I’ve always been interested in learning about HIV/AIDS. I feel the problem is that the general population doesn't think that it can happen to them so many people are not getting tested. In addition, surprisingly, I learned that many private practice physicians do not routinely offer HIV testing to their patients because it requires separate informed consent (thus more paperwork) and the blood work takes extra patient time. The end result is that we have a population with staggering HIV numbers.

According to the Centers for Disease Control and Prevention, more than 1.1 million people in the United States are infected with HIV, and 232,700 don't know it.

The oral cavity is one of several places where HIV infection is found, so dentists have a unique opportunity to identify signs of HIV and incorporate rapid HIV testing of oral fluids in their daily practices. I decided this year that I was going to offer the test to each and every patient in my practice. The OraQuick ADVANCE test is very easy, requires only a swab of the patient’s mouth and the results are available in 20 minutes. Administering the test is fast and we've managed to incorporate it into our practice flow very easily. Knowing as soon as possible enables HIV positive patients to (a) change their behavior to protect others, help prevent the spread of HIV and access the necessary treatment and counseling services which will help them to live a long and healthy lives.

In June 1981, the CDC issued its first warning about a rare form of pneumonia, which later was determined to be AIDS-related. It's been almost 30 years since HIV/AIDS first appeared on the health community's radar. How do you think dentists' attitudes towards treating patients with HIV/AIDS have changed in that time?

Under the Americans with Disabilities Act (AwDA), dentists have a legal obligation to treat patients with HIV/AIDS.

I believe that over the past 28 years we as healthcare providers have become more educated (and less ignorant) about the disease and have become less prejudice towards those suffering from HIV/AIDS. Dentists who have been properly educated and practice universal precautions are more likely to have more positive attitudes today and are not concerned about contracting HIV/AIDS during treatment.

Who performs the rapid oral HIV test?

My entire staff (including administrative staff) is trained to perform the rapid oral HIV test. However, when performing the test in the office during routine patient care, we've decided to have only the licensed clinical staff (dentist and hygienist) perform the test with patients while the administrative staff keeps track of the time. When performing the test off site, like at health fairs, the entire staff will aid in testing and keeping time.

How often do you recommend patients receive the rapid oral HIV test?

I recommend that all patients who have never been tested for HIV, at least get tested once to confirm their status.

The CDC recommends patients to consider getting tested at least once a year for those who engage in behaviors that can transmit HIV infection. These include:

  • Injecting drugs or steroids with used injection equipment
  • Having sex for money or drugs
  • Having sex with an HIV-infected person
  • Having more than one sex partner since your last HIV test
  • Having a sex partner who has had other sex partners since your last HIV test
  • Because it can take up to 4-6 weeks for HIV antibodies to appear in the body after initial exposure, we recommend the following:

    For those who have tested preliminary negative, but may have engaged in risky behavior or may have been exposed 3 months prior to taking the test, we advise taking a repeat test 3 to 6 months later. There is a small chance that you were tested during the "window period," meaning that you were infected within the past 3 months but your body hasn't produced detectable levels of HIV antibodies to yield a positive result. The key is, however to change your behavior during that time by only engaging in safe sex and taking all other precautions to limit exposure so that the follow up test results are accurate.

    If you have tested preliminary negative and are confident that you have had no chance of exposure to the HIV virus, then I'd recommend taking the oral rapid HIV test annually just to confirm your status. The idea is to make this a routine test like your yearly physical test with your medical doctor. That's why doing it at the dental office is such a perfect setting since you need to see your dentist at least twice yearly, every 6 months.

    Are special precautions taken to ensure the results remain confidential?

    Our clients HIV status results are kept with the rest of their dental records and locked securely in our file cabinets. We respect our client’s privacy and follow the Health Insurance Portability and Accountability Act (HIPAA). We deliver test results only to the clients being tested and deliver post test counseling in a discrete setting in our office. We do not disclose test results (positive or negative) to spouses, family members, or friends. We are however, legally required to report all HIV positive results to the New York City Department Health and will refer HIV positive patients to their primary care physician for treatment or one of our treatment center partners.

    Is the test covered under dental insurance plans or health care plans?

    Unfortunately at this time, HIV testing is not considered a billable dental service for insurance payment or reimbursement. The reason dental insurances will not cover HIV testing is because it is considered solely as a medical procedure. In order to bill for HIV testing, a separate claim form must be submitted to the patient’s medical insurance. The proper form is called a CMS 1500 and the current CPT Code is 86701. Just remember, dentists who submit medical claims for HIV testing will not be a preferred provider on the patient’s health insurance plan and will be considered an out of network provider with out of network reimbursement fees. In order for dentists to start getting paid for HIV testing, we will need The American Dental Association along with other dental organizations, dental office staff, dental claims reviewers, and other activists to pull together and convince the Federal Government under the Health Insurance Portability and Accountability Act (HIPAA) as well as Council on Dental Benefits to recognize this as the new standard of care and create a dental procedure code (CDT code) for dental billing.

    What has been the reaction so far from your patients?


    Overall, the patient response has been great! After testing, most patients have stated that they preferred rapid testing with OraQuick ADVANCE because the test was effortless. Others have said that the dental setting made the test feel a tad bit less threatening. I’ve had many patients opt to take the test for the first time in my office because it was convenient and one less trip to the medical doctor’s office.

    I have, however, had a handful of clients that were just as anxious about testing in the dental office as if they had undergone traditional testing in a medical setting, but found themselves relieved after receiving the results before leaving the dental office. The cool thing is that some of our patients have begun spreading the word about how they tested for HIV in the dental office via Twitter and Facebook to their network of friends. This is such an excellent way to help make the message of getting tested more viral and hopefully encourage more people to know their status.

    Know Your Status

    Providing alternative avenues for HIV testing will hopefully instigate a drop in the numbers on undiagnosed HIV infections.


    If you have questions about HIV testing or you would like information on where you can receive a rapid HIV test, please speak with your doctor, or contact your local health authority for locations.

    Sources:

    Centers for Disease Control and Prevention. "The HIV/AIDS Epidemic in the United States Is REAL — Get the Facts!" http://www.nineandahalfminutes.org/get-the-facts.php. Accessed: October 12, 2009

    Interview with Dr. Catris Austin, VIP Smiles. September 2009.

    Interview with Ron Ticho, Vice President - Corporate Communications, OraSure Technologies. September 2009.

    Mark Cichocki, R.N. How is HIV/AIDS Diagnosed?. http://aids.about.com/od/hivtesting/a/hivdiag.htm. Accessed: October 14, 2009.

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