Which At-Home HIV Test Is Best?

Human immunodeficiency virus (HIV), is a sexually transmitted infection (STI) that affects around 1.2 million people in the United States. Medications are available to help control the virus and better ensure a long, healthy life. But to get treated, you need first to get tested.

This is where at-home HIV tests can help. Available for purchase online and from many drugstores and pharmacies, these products allow people to test themselves in the privacy of their own homes. The tests are also sometimes available at low or no cost through local health departments or community-based HIV charities.

This article will explain the benefits and limitations of at-home HIV tests and describe the types of products used for self-testing. It will also provide information about what to do when the test result is positive or negative.

Benefits of At-Home Testing

Around 13% of people living with HIV in the United States are undiagnosed. These individuals are not only at greater risk of illness and death but are also of passing the virus to others.

In some cases, a person may not be aware they have HIV because symptoms may only develop years after exposure. But, in many cases, a person may strongly suspect they have HIV but still avoid testing due to common concerns, including:

• Worries about privacy or anonymity
• Discomfort with counseling or discussions about sex
• The stress of waiting for a test result
• The stigma of being at an HIV testing site

At-home HIV tests can help overcome issues like these. The tests ensure confidentiality and offer users a sense of control and self-empowerment.

Some studies suggest that at-home testing increases the likelihood of partner testing and may reinforce safer sex practices if couples are aware of their HIV status.

Limitations of At-Home Testing

As beneficial as at-home tests may be, they also have their limitations. Before purchasing an at-home test, it is important to understand the potential drawbacks of self-testing.

Accuracy

Although newer-generation at-home tests boast high levels of accuracy, they are prone to user error and false-negative results (meaning the test indicates you don't have HIV even though you do).

False-negative results are common if you test yourself too early during the so-called window period. The window period is the time between the initial infection and when a test can reliably detect the infection. Unlike in-office HIV tests, at-home tests generally have a longer window period and, in turn, a greater risk of false negatives.

Across the board, newer-generation at-home tests have high levels of sensitivity (meaning the percentage of tests that are correctly negative) and specificity (meaning the percentage of tests that are correctly positive). Many report specificity of over 99%. This means that the risk of a false-positive result (when the test indicates you do have HIV even though you don’t) is low.

With that said, at-home tests that rely on saliva tend to be less sensitive than mail-in tests that rely on blood. As such, oral HIV tests are more likely to return false-negative results.

Cost

At-home HIV tests can cost anywhere from $40 to $100, which may be prohibitive for people on a fixed or low income. Generally, insurance will not cover the cost of an at-home HIV purchased online or over the counter.

With that said, the cost of an at-home test may be an eligible expense if you have a health savings account (HSA) and a flexible spending account (FSA). Check with your insurance provider.

Entry to Care

While it has long been suggested that at-home HIV tests incentivize people to seek HIV-specific care if they test positive, studies have yet to support the claim.

A 2021 review in BMC Medicine concluded that, based on an evaluation of 10 studies involving 9,760 people, individuals who used at-home tests were 17% less likely to be linked to care than those who tested in a clinic.

While user error and false-negative results may have contributed to the findings, the researchers suggested that the lack of pre-test counseling and support also played key roles.

Types of HIV Tests

At-home HIV tests detect either immune proteins produced by the body in response to the virus, called antibodies, or structural proteins on the surface of the virus, called antigens.

There are two categories of testing technologies used for at-home testing: antibody-only tests and combination antigen-antibody tests.

Antibody-Only Tests

There are some at-home tests that detect HIV antibodies only. They use a technology called enzyme-linked immunosorbent assay (ELISA) that works by mimicking the body's immune defense.

Whenever the immune system produces antibodies in response to HIV, the antibodies will "tag" the virus for destruction by attaching to a unique antigen on the virus's surface, The antigen involved with HIV is called p24.

Combination Antigen-Antibody Tests

ELISA tests work by introducing p24 into a sample of saliva, blood, or urine. If HIV antibodies are present, the antibodies will attach to the antigen and trigger a positive result.

As per their name, combination antigen-antibody tests detect both HIV antibodies and HIV antigens. It combines ELISA technology and another technology called a p24 antigen test.

The p24 antigen tests work by introducing "clones" of HIV antibodies (called monoclonal antibodies) into a sample of blood. If HIV is present, the p24 antigen on the surface of the virus will attach to the antibody clone, triggering a positive result.

Combination antigen-antibody tests are the preferred method of HIV testing in the United States but can only be used on blood.

At-Home Testing Options

There are many different at-home HIV tests available today, and it can be difficult to know which one to choose. While some may be more expensive than others, they may not necessarily be "better" or more accurate than less expensive ones.

Broadly speaking, the two types of at-home HIV tests to choose from are:

• Rapid self-tests: These tests are performed entirely at home and can produce results within 20 minutes. The tests only detect HIV antibodies. The only licensed rapid self-test in the United States is saliva-based. (The one blood-based rapid self-test is not available in the United States.)
• Mail-in tests: This is a kit that contains supplies to collect a dried blood sample from a finger-stick at home. The sample is then sent to a lab for testing, and the results are returned via a secured website. Most mail-in tests detect both HIV antigens and antibodies, although a few detect antibodies only.

What to Expect

Before performing an at-home HIV test, it is important to read the instructions carefully to ensure you do it right. This includes knowing if you are testing too early during the window period. If in doubt, call the manufacturer's toll-free hotline printed on the product label or insert.

How to Perform a Rapid Self-Test

Only one rapid at-home HIV test (called the OraQuick In-Home HIV Test) is approved by the Food and Drug Administration (FDA).

The kit includes a test stick that you use to swab your gums. The stick is then placed in a tube with a testing solution, called a reagent, that causes a color change if HIV antibodies are present.

To perform a rapid HIV self-test, do the following:

1. Open the box, which contains a sealed package and a plastic test tube stand.
2. Tear open the package and remove the test tube.
3. Remove the cap of the test tube that contains the reagent.
4. Place the test tube in the test tube holder.
5. Remove the test stick from the sealed package. Do not touch the pad of the test stick.
6. Swipe the pad of the test stick along the entire length of your upper gum once and your lower gum once.
7. Place the test stick into the test tube.
8. Wait 20 minutes. Do not leave it in for longer than 40 minutes.
9. Check the window on the handle of the test stick for the results.

The results are interpreted based on the presence or absence of pink lines in the window. Next to the window are the embossed letters "C" and "T."

The results can be interpreted as follows:

• Negative: There is one line next to the "C" and no line next to the "T."
• Positive: There is one line next to the "C" and one line next to the "T" (even a faint one).
• Indeterminate: There is either (a) no line next to the "C," (b) the entire window is pink and difficult to read, or (c) there is a line, but it is neither next to the "C" nor "T."

Indeterminant tests need to be repeated.

How to Perform a Mail-In Test

There are many companies that offer mail-in HIV tests. These include manufacturers that offer comprehensive kits that test for HIV and other STIs.

Most kits include a small retractable cutting tool called a lancet, a collection card onto which blood drops are placed, and a sealable biohazard bag. There will also be an alcohol swab, a piece of gauze, an adhesive bandage, and a prepaid shipping label or envelope.

Once you receive a mail-in kit, you need to register the PIN number included in the kit on the secure website. You will then be asked a series of questions about yourself, including your age, sex, race/ethnicity, general location, and risk factors for HIV. You do not need to give your name or address.

To perform the finger-stick test:

1. Open the package and lay the contents on a table.
2. Select the finger you want to draw blood from. You generally will get the best draw from the middle fingers.
3. Tear open the alcohol swab and wipe the finger to sterilize.
4. Place the tip of the lancet on the middle of your finger. Most lancets are spring-loaded and will quickly puncture the skin when you press the trigger.
5. Lightly press the skin to draw a drop of blood.
6. Place some blood on the collection card in the designated spaces. Be sure to fill the entire space.
7. Wipe your finger with the gauze and apply the adhesive bandage.
8. Place the collection card in the biohazard envelope and seal it completely.
9. Mail the sample to the manufacturer using the prepaid shipping label or envelope.
   

You can access your results on the secure website, usually within two to five days.

As with the rapid HIV self-test, the results of a mail-in HIV test will either be negative, positive, or indeterminate.

Top Options

There is currently only one rapid HIV self-test available in the United States. All others are mail-in tests (also sometimes referred to as home-to-lab tests)

What to Do Once You Get Your Results

The results of an at-home HIV test are no different than those delivered by in-office HIV tests. The three possible results are:

• Negative: This means that the test did not detect evidence of HIV antibodies and/or antigens.
• Positive: This means that the test detected HIV antibodies and/or antigens.
• Indeterminate: This means that the test is neither negative nor positive. An indeterminate test may either show a weak positive result or simply be difficult to interpret.

No matter the findings, it is important to call the toll-free hotline on the product label to discuss the results with a trained HIV counselor.

Even if the test is negative, you might still have HIV if you tested within the window period. If there is a chance of this, you may be advised to retest yourself at a later date.

If the test is positive, it is not considered definitive until it is confirmed with a second test using different testing technology. This second test would need to be performed in a clinic or lab.

If the confirmatory test is positive, the result can be considered definitive. At that stage, HIV therapy would be started to slow the progression of the disease and prevent illness.

If the result is indeterminate, the test needs to be repeated. However, it is important to speak with the hotline counselor to find out if you made any mistakes that may have contributed to the result.

HIV Prevention

Knowing your HIV status is the first step to protecting yourself and others. If the result is negative, you can change certain practices to reduce your risk of infection. If the result is positive, you can take steps to avoid passing the virus to others and avoid reinfecting yourself.

There are several key ways to do this, including:

• Reduce your number of sex partners. The more sex partners you have, the greater the risk of infection. This not only includes HIV but other STIs like syphilis, gonorrhea, and chlamydia.
• Ask about PrEP. HIV pre-exposure prophylaxis (PrEP) is a strategy used to prevent infection in people who don't have HIV. It involves the daily use of the antiretroviral drug Truvada or Descovy, which can reduce the risk of getting HIV by over 90%.
• Get undetectable. If you have HIV, starting antiretroviral therapy can suppress the virus to undetectable levels where it can do the body little harm. At the same time, having an undetectable virus reduces the odds of infecting someone else to zero.
• Use condoms. Even if you are on PrEP or antiretroviral therapy, condoms can still protect you from other incurable STIs like genital herpes, hepatitis B, and human papillomavirus (HPV). On their own, external (male) condoms reduce the risk of HIV by 90%, while internal (female) condoms reduce the risk by 92%.
• Avoid sharing needles. The shared use of needles, syringes, and other drug paraphernalia is the third most common cause of HIV next to anal or vaginal sex. If you inject drugs, there are free needle exchange programs (NEPs) in many states that allow you to dispose of old needles and replace them with new ones. Call your state health department for information.

Summary

At-home HIV tests are alternatives to in-office HIV tests. Beyond their convenience, at-home tests may be ideal for people who would otherwise avoid HIV testing due to concerns about confidentiality or the potential stigma of being seen at an HIV testing site.

There are two testing options available in the United States: a saliva-based rapid HIV test (called OraQuick) that can deliver results in 20 minutes and mail-in tests that require a finger-stick blood sample that is sent to a lab. Saliva-based tests detect HIV antibodies, while most finger-stick blood tests detect both HIV antibodies and HIV antigens.

The tests will either return a negative, positive, or indeterminate result. Positive results need a second confirmatory test performed by a healthcare provider to be considered definitive. If an indeterminate result is returned, the test needs to be repeated.

Although at-home HIV tests are highly accurate, they are vulnerable to user errors and false-negative results (such as can occur if you test during the window period). The cost of at-home tests should also be considered as they may not be covered by insurance.

A Word From Verywell 

As scary as HIV tests may seem, it's important to get tested as there are medications today that can control the virus and ensure you live a long, healthy life if you test positive. HIV treatment can also ensure that you are less able to pass the virus to others.

Many people avoid HIV testing because they don't consider themselves to be at risk or think that HIV is "someone else's" disease. But the fact is that anyone who has ever had sex is at potential risk of infection.

It is for this reason that the U.S. Preventive Services Task Force recommends one-off HIV testing for all people in the United States ages 15–65 as part of a routine healthcare provider visit.