Behavioral Health Is Essential To Health • Prevention Works • Treatment Is Effective • People Recover

Fall 2011 • Volume 10 • Issue 4

ADVISORY

Rapid HIV Testing in Substance Abuse 

Treatment Facilities
 

Rapid HIV tests are screening tests used to detect 

HIV infection. These tests provide negative 

results and preliminary positive results in minutes, 

compared with traditional or conventional HIV 

test results that can take 1 to 2 weeks to obtain. 

The faster availability of HIV test results enables 

substance abuse treatment providers to more quickly 

provide appropriate referrals for HIV treatment for 

clients. This Advisory contains basic, introductory 

information about the benefits of and requirements 

for incorporating rapid HIV testing (RHT) into 

substance use disorder (SUD) treatment programs. 

Additional sources of information are included on 

page 7. 

Why Test for HIV in SUD 

Treatment? 

People entering substance abuse treatment are at high 

risk for having HIV infection. For example, in 2006, 

people who injected drugs accounted for 18.5 percent 

of people infected with HIV (15.9 percent of men and 

26.3 percent of women).1

 Further, most heterosexual 

transmission, as well as transmission between men 

having sex with men, involves alcohol or drug use. 

Testing in an SUD treatment facility provides an opportunity to address the broad role of alcohol and drug 

use that places people at risk for HIV transmission and 

provides those people with prevention counseling. The 

Centers for Disease Control and Prevention (CDC) 

estimates that approximately 20 percent of Americans 

who are HIV positive are unaware of their infection.2 

However, the CDC revised its HIV testing and counseling recommendations in 2006 to include testing of 

all adults (especially pregnant women) and adolescents 

during routine medical care.3

 Despite clients in SUD 

treatment being at higher risk of having HIV infection 

than is the general population, less than 30 percent 

of SUD treatment facilities reported testing for HIV.4 

Hospital inpatient treatment facilities (79 percent) are 

reported to be more likely than nonhospital residential 

facilities (41 percent) or outpatient treatment facilities 

(24 percent) to provide HIV testing.4 Facilities that 

provide medication-assisted treatment for opioid use 

disorders and hospital-based treatment facilities have 

higher rates of testing than do other types of SUD 

treatment facilities, such as those that provide intensive outpatient treatment. 

What Is Rapid HIV Testing? 

Rapid HIV tests are Food and Drug Administration­

(FDA-) approved HIV diagnostic devices that provide 

test results in less than 20 minutes, upon applying 

the sample to the device. These devices are typically 

small in size, thus portable, and their operation does 

not necessitate sophisticated instrumentation. The 

devices can be used in SUD treatment facilities, 

healthcare and HIV outreach clinics, needle-exchange 

programs, healthcare providers’ offices, sexually 

transmitted disease clinics, perinatal clinics, emergency 

departments, and other venues. Sophisticated 

instrumentation is not needed to perform the tests. 

Depending on which RHT device is used, negative and 

preliminary positive test results can be obtained in 20 

to 40 minutes. Negative results are considered final, 

except during the window period. This is the period 

after infection but before antibodies can be detected by 

an HIV test. It varies from approximately 8 to 12 weeks, 

depending on the type of test.5

 If the person could be 

in the window period, another sample should be taken 

at the confirmatory facility after a few weeks to allow 

HIV antibodies to mature. People at high risk—such 

as those who inject drugs—need to be tested annually3 

and people who think they may be in the window period 

need to be retested. 

What Are the Benefits of RHT? 

Increased access to HIV services 

Much HIV testing is performed using a traditional 

laboratory test, which requires the person to return a 
Behavioral Health Is Essential To Health • Prevention Works • Treatment Is Effective • People Recover 

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ADVISORY

In the recent Substance Abuse and Mental Health Services Administration- (SAMHSA-) funded Targeted Capacity 

Expansion Program for Substance Abuse Treatment and HIV/AIDS Services (TCE/HIV) awards, grant recipients 

were required to offer all clients rapid HIV preliminary antibody testing during outreach, pretreatment, or program 

enrollment. Data collection is ongoing and includes obtaining information on type of treatment site (e.g., inpatient, 

outpatient), treatment population demographics (e.g., gender, ethnicity, race, age), prior HIV testing history, reasons 

for taking or refusing HIV testing, rapid HIV test results, confirmatory HIV test results, and type of services provided. 

Between November 2009 and August 2010, 3,692 TCE/HIV grantee clients were tested for HIV. Client information was 

coded and entered into a secure database to ensure client HIV information remained confidential. Preliminary findings 

indicate that 6.7 percent (248 clients) of those tested were HIV positive (SAMHSA Unpublished Data, 2010). Of those 

who were HIV positive: 

● 37.1 percent reported any drug or alcohol risk behavior in the last 30 days. 

● 27.4 percent reported cocaine use in the last 30 days. 

● 23.0 percent reported marijuana use in the last 30 days. 

● 22.2 percent reported alcohol use in the last 30 days. 

● 14.1 percent reported having sex while under the influence of drugs and/or alcohol in the last 30 days. 

few weeks later to receive the results. Thirty to 40 percent 

of those tested with the traditional HIV test do not return 

to receive their test results.6

 Often, those who do not 

return are those at high risk of HIV infection.7

 Because 

RHT provides negative and preliminary positive results 

on the same day, more people receive their test results 

than if tested using the traditional method. Fewer people 

are lost to HIV testing followup, even if they drop out 

of SUD treatment. In a comparison of clients who were 

tested using traditional tests with clients who were tested 

using RHT devices, a meta-analysis found that those tested 

with RHT were 1.5 to 2.2 times more likely to receive 

their HIV test results.8 Therefore, RHT may increase the 

number of individuals who become aware of their HIV 

status and receive HIV counseling, education, and medical 

care.6, 9 

Prevention of late diagnosis of HIV 

An HIV diagnosis is considered late if a person is 

diagnosed with AIDS less than 1 year after the date of the 

HIV diagnosis.10 Between 2004 and 2006, approximately 

40 percent of people who injected drugs and who were 

also unknowingly infected with HIV received late 

diagnoses.10 AIDS is a consequence of HIV infection 

and represents a late stage of disease progression. 

Consequently, late diagnoses delay and complicate 

medical treatment and result in worse treatment outcomes, 

including a reduction in life expectancy.10 

HIV infection disproportionately affects different ethnic and 

racial populations in the United States. Among the estimated 

number of people with HIV infections, African Americans, 

Hispanic Americans, and American Indians/Alaska Natives 

had higher rates of infection in 2006 than Caucasian or 

Asian/Pacific Islander Americans.1

 In addition, people 

receiving late diagnoses were also disproportionately from 

these minority groups.11 These populations traditionally 

have less access to medical and preventive care, including 

HIV testing. RHT may increase access to HIV treatment by 

increasing the number of people who can determine their 

HIV status. RHT can be easily offered in nontraditional 

settings (e.g., SUD treatment and outreach clinics) and 

offer more opportunities for testing to people who are 

underserved medically.11 

Improved SUD treatment outcomes 

Determining a client’s HIV status while the person is in 

SUD treatment may have several benefits. Clients will 

be informed about their preliminary HIV status and, 

if needed, offered additional testing, counseling, and 

treatment. Such treatment could be enhanced and made 

more effective by taking into account the client’s HIV 

status and tailoring SUD treatment for those who are 

receiving HIV-treatment medications. 

Prevention of adverse medication 

interactions 

Some clients entering SUD treatment do not reveal that they 

are receiving treatment for HIV/AIDS, possibly because of 

the fear of a negative reaction. However, this information 

helps the healthcare provider choose appropriate SUD 

medication and dosages that may help a client avoid adverse 

interactions between HIV and SUD medications (e.g., 

methadone).12, 13 
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Rapid HIV Testing in Substance Abuse Treatment Facilities

Fall 2011, Volume 10, Issue 4

Improved satisfaction with the HIV 

testing process 

RHT has been shown to be acceptable to clients and 

counselors. In a study of 1,610 clients at a communitybased clinic that offered RHT and traditional HIV testing, 

91 percent of the clients chose RHT. Both counselors and 

clients were more satisfied with the RHT experience than 

the traditional testing experience.14 Other studies have 

found similar levels of acceptance for RHT.15, 16 The anxiety 

experienced by clients while waiting several days for 

traditional HIV test results is also lessened. 

Improved HIV treatment outcomes 

Without antiretroviral medications for HIV, most 

people infected with the virus will progress to AIDS in 

approximately 10 years.9

 RHT can help determine the 

presence of antibodies after infection and before the 

development of AIDS and can facilitate early referral 

for diagnosis and medical care, preventing unnecessary 

morbidity and mortality. 

Improved HIV/AIDS prevention 

Because RHT can increase the number of people who know 

their HIV status, it can help reduce HIV transmission. There 

is some evidence that knowing one’s HIV status results in a 

decrease in risky behaviors.17 One study found that behavior 

change was motivated by concerns about infecting others 

and that the initial diagnosis of HIV promoted behaviors that 

reduced the risk of infecting others, at least in the early stage 

of the infection.18 For pregnant women in SUD treatment 

who have not received routine prenatal care, screening for 

and identifying and treating HIV infection can help prevent 

perinatal transmission.3

 Once a person is diagnosed and 

receiving antiretroviral therapy, the risk of HIV transmission 

is lessened.19 

What Regulations Exist About RHT? 

The FDA has approved seven RHT devices to date (Exhibit 1). 

RHTs are considered point-of-care tests (POCTs) because the 

sample is collected from the client and the test is performed 

at the same location. The sample does not need to be sent for 

testing at another facility, such as a laboratory. 

To use POCTs legally in settings without a certified 

laboratory, treatment programs need to use tests that have 

Exhibit 1. Information Sources: 

FDA-Approved RHT Devices
 

FDA-Approved Rapid HIV Antibody Screening Tests 

(comparison chart) 

http://www.cdc.gov/hiv/topics/testing/rapid/ 

rt-comparison.htm 

FDA-Approved Rapid HIV Antibody Screening Tests— 

Purchasing Details 

http://www.cdc.gov/hiv/topics/testing/rapid/ 

rt-purchasing.htm 

Complete List of Donor Screening Assays for Infectious 

Agents and HIV Diagnostic Assays 

http://www.fda.gov/BiologicsBloodVaccines/ 

BloodBloodProducts/ApprovedProducts/ 

LicensedProductsBLAs/BloodDonorScreening/ 

InfectiousDisease/UCM080466.htm 

been granted a Certificate of Waiver under the Clinical 

Laboratory Improvement Amendments (CLIA) of 1988. 

CLIA classifies tests according to accuracy and reliability, 

and complexity of performing the test. To receive a CLIA 

waiver, a test must: 

●		Use direct, unprocessed specimens (e.g., urine, whole 

blood, oral fluid). 

●		Be easy to perform. 

●		Have a small chance of error. 

People who do not have formal laboratory technology training 

can use CLIA-waived testing devices. Not all FDA-approved 

RHT devices have received CLIA waivers, however. Exhibit 2 

provides information sources about CLIA waivers. 

To administer POCTs, facilities must register with the Centers for Medicare & Medicaid Services (CMS) and become 

CLIA-certified. To use RHT devices, facilities must also 

comply with basic fundamentals of HIV/AIDS training as 

mandated by individual States and with State regulations 

for HIV counseling, testing, and referrals. State laws differ 

Exhibit 2. Information Sources: 

CLIA Waivers 

CLIA Certificate of Waiver Fact Sheet 

http://www.cdc.gov/hiv/topics/testing/resources/ 

factsheets/roltCLIA.htm 

How to Obtain a CLIA Certificate of Waiver 

https://www.cms.gov/CLIA/downloads/ 

HowObtainCertificateofWaiver.pdf 
Behavioral Health Is Essential To Health • Prevention Works • Treatment Is Effective • People Recover 

4 

ADVISORY

regarding who may perform these services and who may 

disclose an individual’s HIV status to others. Trained 

service providers need to maintain a copy of their State’s 

compliance documentation on RHT. The National HIV/ 

AIDS Clinicians’ Consultation Center provides information on each State’s HIV testing laws and policies in its 

2011 Compendium of State HIV Testing Laws 

(http://www.nccc.ucsf.edu/consultation_library/ 

state_hiv_testing_laws). 

How Is Testing Done With RHT 

Devices? 

RHT kits include all of the necessary items to perform 

the test, including the testing device, reagents, specimencollection device, step-by-step instructions for performing 

the test, and an information sheet for clients. In some 

kits, the specimen-collection device is also the testing 

device. Broadly speaking, if present in the specimen, antiHIV antibodies produced by the body’s immune system 

in response to the presence of HIV infection will cause 

a color change on the device. This change in color on 

the testing device indicates whether the test is reactive 

to antibodies (preliminary positive) or is nonreactive 

(negative). The testing device must be read within a strict 

timeframe to be accurate. The timeframe is different for 

each device, and the information is included in the kit.20 

For more specific information on performing the test and 

result interpretation, the package insert specific to each 

test must be consulted closely. If the result is reactive, or 

a preliminary positive, the rapid test must be followed by 

a confirmatory test (see Confirmatory testing of a positive 

RHT result). 

When choosing an RHT device, each facility should 

decide which device best fits its program. CMS provides 

information on CLIA-waived testing devices (see Exhibit 

2). RHT devices that are currently waived by CLIA use 

oral fluid or whole blood as the testing sample. Oral 

fluid is collected from the gums; the procedure for taking 

blood samples varies. The specimen is then placed 

into the designated area in the testing device.20, 21 The 

person administering the test must follow infectiousdisease precautions (e.g., wearing gloves) and dispose of 

biohazardous materials properly. The National Institute for 

Occupational Safety and Health provides information on 

biohazardous waste disposal and ensuring safety of staff at 

http://www.cdc.gov/niosh/docs/88-119/waste.html. 

Medical personnel can perform specimen collection and 

testing, as well as provide HIV counseling, if they are on 

staff at the treatment facility. However, counselors and 

paraprofessionals without medical background, but who 

receive training, can collect specimens, administer and read 

tests, provide pretest and posttest counseling, and document 

test results. Training must include specimen collection, 

test administration, reading of results, documentation, 

quality control procedures, client interactions, and HIV-test 

counseling procedures. Knapp and colleagues22 developed 

a training program for paraprofessionals to perform 

RHT in nonclinical settings and found that testing by 

paraprofessionals was cost-effective and freed highly trained 

healthcare staff to work with clients already identified 

as HIV positive. In another study, AIDS counselors 

successfully performed RHT and counseling services after 

receiving appropriate training.23 When implementing an 

RHT program, a facility can decide which staff members 

will administer the test and counsel clients according to the 

program’s needs and staffing patterns. 

Confirmatory testing of a positive RHT 

result 

A preliminary positive RHT result must be followed up 

soon with a laboratory confirmatory test that is performed 

by highly trained personnel.21 Confirmatory testing 

can be done on blood or oral fluid specimens, although 

blood specimens have higher accuracy than oral fluid 

specimens.21 The client is told that the positive result 

is preliminary and that additional laboratory testing is 

needed. The client must understand that the result is the 

initial screening result and is not definite. If possible, a 

vial of blood is drawn from the client at the facility and 

sent to a laboratory. If the facility does not have medical 

personnel to draw a blood specimen, the client needs to 

be referred elsewhere for confirmatory testing. Having the 

ability to collect specimens for confirmatory testing at the 

treatment facility may improve followup because some 

clients may not go for confirmatory testing as asked. Client 

refusal of confirmatory testing should be documented. In 

traditional HIV testing, the sample that initially tests HIV 

positive is retested using different types of tests to confirm 

the findings. Thus, RHT provides a preliminary positive 
Behavioral Health Is Essential To Health • Prevention Works • Treatment Is Effective • People Recover

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Rapid HIV Testing in Substance Abuse Treatment Facilities

Fall 2011, Volume 10, Issue 4

result, while traditional testing represents a sequence of 

tests that provides the final result. Due to these testing 

procedures and other considerations, obtaining results 

from traditional HIV testing takes longer (1 to 2 weeks) 

compared with RHT. 

If the test result is positive, the person is considered to be 

infected with HIV, but it does not necessarily mean the 

person has AIDS. A diagnosis of AIDS is not based only 

on the detection of HIV infection, but on several other 

factors as well, such as blood counts and the presence of 

HIV-related illnesses. 

Discordant test results 

If the laboratory confirmatory test result of a positive RHT 

is negative or indeterminate, it is considered a discordant 

test result—that is, one that does not agree with the RHT 

result. Another laboratory test needs to be performed using 

a new specimen to determine the person’s HIV status. 

However, in one large study of people with discordant 

HIV test results, only one-half followed through with the 

repeat testing. Of those who did, nearly one in five was 

infected with HIV.24 

What Procedures Are Needed to 

Implement RHT? 

The SUD treatment facility needs to develop policies and 

procedures for conducting RHT. These policies need to 

include mechanisms to ensure that the facility meets all 

applicable Federal, State, and other regulatory requirements. 

Quality assurance plan 

To conduct RHT, a facility must develop a quality 

assurance (QA) plan21 (Exhibit 3). The QA plan should 

address records management, self-monitoring protocols, 

and test reliability and validity. The plan should identify 

QA monitors (e.g., senior staff members, consultants, 

supervisors) who identify breaches in procedures, 

ensure that testing mistakes are followed by appropriate 

corrective actions, and ensure that external controls are 

performed (see External control testing). Once the QA plan 

is in place, all appropriate staff members need to be trained 

and evaluated in adhering to procedures. Communication 

mechanisms are needed for reporting QA issues so that 

they can be rectified. If more than one staff member makes 

Exhibit 3. Information Sources: 

Quality Assurance 

Quality Assurance Guidelines for Testing Using 

Rapid HIV Antibody Tests Waived Under the Clinical 

Laboratory Improvement Amendments of 1988 

http://www.cdc.gov/hiv/topics/testing/resources/ 

guidelines/pdf/qa_guidelines.pdf 

Provisional Procedural Guidance for Community Based 

Organizations 

http://www.cdc.gov/hiv/topics/prev_prog/ahp/ 

resources/guidelines/pro_guidance/index.htm 

a particular error there may be a need for retraining or 

changes in training.25 

According to the CDC21 if confirmatory specimens are 

collected onsite, the facility needs to establish procedures 

for: 

●		Collecting, labeling, processing, storing, and 

documenting specimen transfer. The referral 

laboratory test requisition should note that the 

specimen is from a person who has had a preliminary 

positive rapid test result. 

●		Transporting the confirmatory test specimens to the 

laboratory. 

● Obtaining confirmatory results from the laboratory. 

● Informing the client of the confirmatory test result. 

● Reporting confirmed positive HIV test results to the 

State health department, as required. 

External control testing 

All RHT programs require periodic external control 

testing to ensure that tests are being administered 

correctly. External control testing kits are available from 

the manufacturer of the RHT kit chosen by the facility. 

The kits include known reactive and nonreactive liquid 

samples (controls); these control samples are surrogate 

samples used to evaluate the integrity of the test system 

and whether the person administers the test correctly.21 

A staff member very familiar with testing procedures 

performs external control testing. This testing is done20, 21 

●		When a staff person is being newly trained to 

administer the tests.
 

●		On receipt of a new shipment of test kits to determine 

whether the devices are working correctly. 
Behavioral Health Is Essential To Health • Prevention Works • Treatment Is Effective • People Recover 

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ADVISORY

●		When a new lot of test kits is opened to determine 

whether the devices are working properly.
 

●		When the temperature of the storage or testing area 

falls outside the recommended range to determine 

whether the devices are still working properly. 

●		At periodic intervals determined by the testing facility, 

usually based on the volume of testing. 

Client information and linkages to care 

FDA requires that people who undergo RHT receive an 

information sheet, which is included in the test kits. The 

sheet includes basic information about HIV/AIDS, how 

the test works, and the meaning of the results; it also 

emphasizes that a preliminary positive result needs to be 

confirmed by a standard laboratory test.20 

Unless HIV treatment is provided at the SUD treatment 

facility, memoranda of understanding between the 

treatment facility and local HIV treatment and other 

providers are needed so that clients needing medical care 

can be referred. Possible referral sites include local health 

departments, AIDS service organizations, HIV/AIDS 

behavioral health care services, HIV/AIDS medical clinics, 

and support services (e.g., housing, food, transportation). 

Case managers may be needed to ensure that clients 

receive necessary information to access those referrals and 

other linkages to care. 

What Kind of Counseling Do 

Clients Need? 

To maintain confidentiality, a private environment 

is needed for pretest and posttest counseling and 

for specimen collection. According to the CDC26, 

HIV counseling for RHT consists of two parts: (1) 

providing information to the client about testing, and 

(2) HIV prevention counseling. All clients must receive 

information about the test and the voluntary nature of 

consenting to testing. Clients need to give informed 

consent for testing (whether the consent is separate or 

part of a general consent for treatment). HIV prevention 

counseling addresses prevention of transmission of HIV by 

emphasizing that the client change his or her behavior to 

reduce risk factors for transmission of HIV infection. 

People providing counseling should stress that positive test 

results are preliminary.26 The manner in which test results 

are delivered can affect the client’s reaction and actions 

afterward (e.g., seeking a confirmatory test for a positive 

RHT result, seeking treatment, changing risky behaviors). 

Delivering and receiving results can be stressful, and 

those providing counseling should be carefully prepared 

for the task. Clients with negative results should receive 

HIV prevention messages to avoid infection. Clients 

with preliminary positive results need counseling on the 

importance of obtaining confirmatory test results and 

reassurance that medical treatment and other services are 

available. This is a stressful time for clients, particularly 

the waiting time between the preliminary positive HIV 

test result and when the findings from the confirmatory 

test are determined. Therefore, a referral for mental health 

counseling may be appropriate to supplement the SUD 

treatment the client is receiving. 

If the confirmatory test result is positive, the client needs to 

be provided linkages to facilities that offer medical evaluation 

and treatment. The client needs to be told about the importance 

of staying in SUD treatment, achieving a healthful lifestyle, 

methods to prevent infecting others, and how HIV/AIDS and 

the anti-HIV medications may affect other medical problems. 

Substantive and detailed information about counseling is 

critical, but a thorough description is beyond the scope of this 

document. Exhibit 4 includes sources of information about 

HIV counseling and HIV prevention. 

Exhibit 4. Information Sources: HIV 

Counseling and Prevention
 

HIV Counseling With Rapid Tests 

http://www.cdc.gov/hiv/topics/testing/resources/ 

factsheets/rt_counseling.htm 

Comprehensive Risk Counseling and Services 

Implementation Manual 

http://www.cdc.gov/hiv/topics/prev_prog/CRCS/ 

resources/CRCS_Manual/pdf/CRCS-Impl-Manual.pdf 

CDC’s RESPECT-2 Counseling Web Site 

http://www.cdc.gov/hiv/topics/research/respect-2/ 

counseling/index.htm 

2009 Compendium of Evidence-Based HIV Prevention 

Interventions 

http://www.cdc.gov/hiv/topics/research/prs/evidencebased-interventions.htm 

Treatment Improvement Protocol (TIP) 37: Substance 

Abuse Treatment for Persons With HIV/AIDS 

http://www.ncbi.nlm.nih.gov/books/NBK14660 
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Rapid HIV Testing in Substance Abuse Treatment Facilities

Fall 2011, Volume 10, Issue 4

 

 

 

 

Resources 

Centers for Disease Control and Prevention, National 

AIDS Hotline 

1-800-CDC-INFO (1-800-232-4636) (English and Español) 

TTY: 1-888-232-6348 

Centers for Disease Control and Prevention, Rapid 

HIV Testing 

http://www.cdc.gov/hiv/topics/testing/rapid 

Health Resources and Services Administration, HIV/ 

AIDS Programs 

http://hab.hrsa.gov 

National AIDS Treatment Advocacy Project 

http://www.natap.org 

National Alliance of State and Territorial AIDS Directors 

http://www.nastad.org 

National Association of People With AIDS 

http://www.napwa.org 

National Association of State Alcohol/Drug Abuse 

Directors 

http://nasadad.org 

National Association of State Mental Health Program 

Directors 

http://www.nasmhpd.org 

National HIV/AIDS Clinicians’ Consultation Center 

http://www.nccc.ucsf.edu/home 

National Institute of Allergy and Infectious Diseases 

http://www.niaid.nih.gov/topics/hivAIDS/understanding/ 

Pages/Default.aspx 

National Institute on Alcohol Abuse and Alcoholism 

http://www.niaaa.nih.gov 

National Institute on Drug Abuse 

http://hiv.drugabuse.gov 

Office of Minority Health 

http://minorityhealth.hhs.gov 

Substance Abuse and Mental Health Services 

Administration Publications 

http://store.samhsa.gov/facet/issues-conditions-disorders/ 

term/HIV-AIDS 

Substance Abuse and Mental Health Services 

Administration, Rapid HIV Testing Initiative 

http://www.samhsa.gov/hivhep/rhti_factsheet02.aspx 

Notes 

1

 Centers for Disease Control and Prevention. (2008). HIV prevalence 

estimates—United States, 2006. Morbidity and Mortality Weekly 

Report, 57(39), 1073–1076. 

2

 Centers for Disease Control and Prevention. (2010). HIV in the United 

States. Retrieved October 6, 2011, from http://www.cdc.gov/hiv/ 

resources/factsheets/us.htm 

3

 Centers for Disease Control and Prevention. (2006). Revised 

recommendations for HIV testing of adults, adolescents, and 

pregnant women in health-care settings. Morbidity and Mortality 

Weekly Report, 55(RR-14), 1–17. 

4

 Substance Abuse and Mental Health Services Administration, Center 

for Behavioral Health Statistics and Quality. (2010). The N-SSATS 

report: Infectious disease screening. Rockville, MD: Substance 

Abuse and Mental Health Services Administration. 

5

 Centers for Disease Control and Prevention. (2009a). HIV testing 

implementation guidance for correctional settings. Retrieved 

October 6, 2011, from: http://www.cdc.gov/hiv/topics/testing/ 

resources/guidelines/correctional-settings 

6

 Franco-Paredes, C., Tellez, I., & del Rio, C. (2006). Rapid HIV 

testing: A review of the literature and implications for the 

clinician. Current HIV/AIDS Reports, 3, 159–165. 

7

 Grusky, O., Roberts, K. J., & Swanson, A. (2007). Failure to return 

for HIV test results: A pilot study of three community testing sites. 

Journal of the International Association of Physicians in AIDS 

Care, 6(1), 47–55. 

8

 Hutchingson, A., Branson, B., Kim, A., & Farnham, P. (2006). A 

meta-analysis of the effectiveness of alternative HIV counseling 

and testing methods to increase knowledge of HIV status. AIDS, 

20, 1597–1604. 

9

 Centers for Disease Control and Prevention. (2009b). Late HIV 

testing—34 States, 1996–2005. Morbidity and Mortality Weekly 

Report, 58(24), 661–665. 

10 Centers for Disease Control and Prevention. (2009c). HIV infection 

among injection-drug users—34 States, 2004–2007. Morbidity and 

Mortality Weekly Report, 58(46), 1291–1295. 

11 Schwarcz, S., Hsu, L., Dilley, J., Loeb, L., Nelson, K., & Boyd, S. 

(2006). Late diagnosis of HIV infection: Trends, prevalence, and 

characteristics of persons whose HIV diagnosis occurred within 

12 months of developing AIDS. Journal of Acquired Immune 

Deficiency Syndromes, 43(4), 491–494. 

12 Bruce, R., Kresina, T., & McCance-Katz, E. (2010). Medicationassisted treatment and HIV/AIDS: Aspects in treating HIVinfected drug users. AIDS, 24(3), 331–340. 

13 McCance-Katz, E., Sullivan, L., & Nallani, S. (2009). Drug 

interactions of clinical importance among the opioids, methadone, 

and buprenorphine, and other frequently prescribed medications: A 

review. American Journal on Addictions, 19, 4–16. 

14 Guenter, D., Greer, J., Barbara, A., Robinson, G., Roberts, J., 

& Browne, G. (2008). Rapid point-of-care HIV testing in a 

community-based anonymous testing program: A valuable 

alternative to conventional testing. AIDS Patient Care and STDs, 

22(3), 195–204. 
ADVISORY

15 Scott, V., Sitapati, A., Sayyida, M., Summers, P., Washington, 

M., Daniels, F. et al. (2009). The Howard University Hospital 

experience with routinized HIV screening: A progress report. 

Transactions of the American Clinical and Climatological 

Association, 120, 429–434.

16 Wurcel, A., Zaman, T., Zhen, S., & Stone, D. (2005). Acceptance of 

HIV antibody testing among inpatients and outpatients at a public 

health hospital: A study of rapid versus standard testing. AIDS 

Patient Care and STDs, 19(8), 499–505.

17 DiFranceisco, W., Pinkerton, S., Dyatlov, R., & Swain, G. (2005). 

Evidence of a brief surge in safer sex practices after HIV testing 

among a sample of high-risk men and women. Journal of 

Acquired Immune Deficiency Syndrome, 39, 606–612.

18 Steward, W., Remien, R., Higgins, J., Dubrow, R., Pinkerton, S., 

Sikkema, K., et al. (2009). Behavior change following diagnosis 

with acute/early HIV infection—A move to serosorting with 

other HIV-infected individuals: The NIMH Multisite Acute HIV 

Infection Study, III. AIDS and Behavior, 13(6), 1054–1060. 

19 Panel on Antiretroviral Guidelines for Adults and Adolescents. 

(2011). Guidelines for the use of antiretroviral agents in HIV-1-

infected adults and adolescents. Retrieved October 6, 2011, from 

http://aidsinfo.nih.gov/contentfiles/AdultandAdolescentGL.pdf

20 Greenwald, J., Burstein, G., Pincus, J., & Branson, B. (2006). A rapid 

review of rapid HIV antibody tests. Current Infectious Disease 

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SAMHSA Advisory

Rapid HIV Testing in Substance Abuse Treatment Facilities

SAMHSA Advisory 

This Advisory was written and produced under contract number 270-09-0307 by the Knowledge Application Program (KAP), 

a Joint Venture of JBS International, Inc., and The CDM Group, Inc., for the Center for Substance Abuse Treatment (CSAT), 

Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services 

(HHS).

Disclaimer: The views, opinions, and content expressed herein do not necessarily reflect the views or policies of CSAT, 

SAMHSA, or HHS. No official support of or endorsement by CSAT, SAMHSA, or HHS for these opinions or for particular 

instruments, software, or resources is intended or should be inferred.

Public Domain Notice: All materials appearing in this document except those taken from copyrighted sources are in the 

public domain and may be reproduced or copied without permission from SAMHSA or the authors. Citation of the source 

is appreciated. However, this publication may not be reproduced or distributed for a fee without the specific, written 

authorization of the Office of Communications, SAMHSA, HHS.

Electronic Access and Copies of Publication: This publication may be ordered from SAMHSA’s Publications Ordering 

Web page at http://www.store.samhsa.gov. Or, please call SAMHSA at 1-877-SAMHSA-7 (1-877-726-4727). The document 

can be downloaded from the KAP Web site at http://www.kap.samhsa.gov.

Recommended Citation: Substance Abuse and Mental Health Services Administration. (2011). Rapid HIV Testing in 

Substance Abuse Treatment Facilities. Advisory, Volume 10, Issue 4.

HHS Publication No. (SMA) 11-4662 

First Printed 2011