Neither of the testing kits available now in the US are true `home tests' in the way that pregnancy testing kits are understood to be. Both require individuals to send off a sample of blood to a laboratory and phone in for a result. Their chief advantages are anonymity and accessibility rather than speed.

The Confide testing kit

Confide is manufactured by Direct Access Diagnostics, a subsidiary of Johnson and Johnson. The testing kit is an over the counter product which consists of a blood specimen collection kit, pre–test counselling booklet and a personal ID number. The test kit can also be ordered by credit card phone line. They cost between $35 and $50 depending on point of sale.

The purchaser uses a retractable lancet to prick a fingertip and place few drops of blood on a paper test card. The card is then sent to the laboratory in a pre–paid envelope.

At the laboratory the sample is tested using a standard ELISA antibody test, with a confirmatory test using another form of test kit if the result is positive. False positives have not been reported in trials of this methodology, and the false negative rate is comparable with standard ELISA testing (5 in 1000).

Results are available in seven days by telephone. The caller gives their ID number to obtain the result. If the result is negative the caller has the option of speaking to a counsellor or recorded information. If the caller is positive or the result is indeterminate, he or she will be referred to a counsellor. Counsellors can refer to treatment centres and callers may use the telephone counselling service for up to two years after diagnosis. There is no way that the testing service can follow up callers if they opt out of the counselling process at any point.

The Home Access test

The Home Access kit is also available from pharmacies or by mail order, price ranging from $40 to $60. The test kit consists of a lancet and a filter paper circle which must be completely filled with blood. The sample is then sent to the laboratory, where it is tested by several ELISA kits. If a sample is positive by two ELISA tests, another test method will be used to confirm the result.

A trial has shown that the test method resulted in no false positive or false negative results when 756 individuals at high risk of HIV infection were tested. However, almost 7% of test kit users had problems providing the blood sample in such a way that it could be tested.

Results are available within three to seven days. Some people with negative results will be referred automatically to a counsellor. Others will be given the option. All callers with positive results are referred directly to a counsellor, who will give them referrals and post–test counselling. As with the Confide test, callers can opt out of the counselling process at any time.