Advances in HIV testing technology and their potential impact on prevention.

Recent advances in HIV testing technology are increasing options for HIV testing which may lead to more persons at risk for HIV infection learning their serostatus. These advances include the development of simple rapid assays with visual reading, several of which can be used with whole blood (including finger stick) or with non-invasive alternative specimens like oral fluids or urine. Many of these new tests are simple enough to be used in nonclinical settings by public health workers or by consumers in the home. For some of these developments, such as rapid testing, enough is now known to recommend their use within specific clinical contexts. For other developments, such as home sample collection, understanding their true impact must wait for postmarketing evaluation. For technologies currently in development, such as true home testing, we are only beginning to understand and address the issues. We, as clinicians and public health practitioners who are interested in prevention, must begin to deal with the issues. We must identify important policy questions, develop a research agenda to begin to answer these questions, and devise strategies to maximize the opportunities for HIV prevention and minimize the potential for harm.