Rapid HIV Test: Accuracy, Procedures, Results

A test that offers results in 20 minutes at home or in a clinic

A rapid HIV test can test for HIV and return the results in a short period of time, usually 20 minutes. There are two kinds of rapid HIV tests: A rapid self-test can be taken in a private location, while a rapid point-of-care test is given at a clinic or healthcare provider's office.

A rapid self-test can be purchased through a pharmacy or online and performed at home. Currently, there is only one FDA-approved rapid self-test, OraQuick. It provides a kit for users to test their own oral fluid sample for HIV. The other type of rapid test, point-of-care (POC) HIV testing, may involve getting a blood drop from the finger, an oral swab, or a urine sample. It does not require the use of specialized lab equipment, and therefore allows healthcare providers to provide immediate results for those looking for same-day testing.

Many states offer rapid HIV testing for free or at a reduced cost. Visiting a clinic or healthcare provider’s office for POC testing may ensure proper coverage. However, if you purchase a home test online or at a pharmacy, health insurance or Medicaid may not cover the cost.

HIV testing can be done at a healthcare provider’s office, health clinic, health department, or Planned Parenthood. Anyone interested in a test is given the option to take a confidential or anonymous HIV test. A confidential test means the results will go into your medical record and your local health department will be able to access the number of HIV patients in the area. If you choose to take an anonymous test, this means you will get an ID number to find out the results and the diagnosis will not go into your medical record.

HIV quick test

Yannick Tylle / Getty Images

When to Take a Rapid HIV Test?

According to the Centers for Disease Control and Prevention (CDC), everyone between 13 and 64 years old should be tested for HIV at least once in their life. People who have sex without condoms, have multiple sexual partners, or share drug equipment are at higher risk for HIV and should be tested more frequently, whether through regular or rapid testing.

If you think you’ve been exposed to HIV within the past 72 hours, contact your healthcare provider or medical professional about post-exposure prophylaxis, which is medication that can prevent HIV after a possible exposure.

After someone has been infected with the virus it can take about two weeks for HIV antigen (protein on the surface of the virus) to be detectable with current antigen tests, and more than three weeks to produce enough HIV antibodies to be detected by antibody tests. In a very small number of people, the process takes up to several months.

There are different window periods for different types of tests:

  • Antigen and antibody tests take blood from a vein, and can detect HIV between 18 and 45 days after exposure
  • Antigen and antibody tests done with blood from a finger prick can detect HIV between 18 and 90 days after exposure
  • Antibody tests can take 23 to 90 days after an exposure to detect HIV. Most rapid tests and self-tests are antibody tests. In general, antibody tests that use blood from a vein can detect HIV sooner after infection than tests done with blood from a finger prick or with oral fluid

No test can detect HIV immediately after someone has been exposed to the virus. If there was exposure, getting a test the following day won’t confirm or rule out infection. During the window period (between exposure and when a test will accurately determine if someone has HIV), a person may have HIV but still test negative.

At Home (Rapid Self-Test)

The rapid self-test is done in the privacy of your home and typically takes 20 minutes to get results. A home test can be purchased at a pharmacy or online. The only FDA-approved test, OraQuick, test checks for antibodies in HIV, which are proteins that the body creates to fight off HIV infection. It can only be sold to those 17 years old and over.

How the Test Is Performed

The test requires the user to swab their gums to collect an oral fluid sample and use the materials in the kit to test the sample. The user must follow the test manufacturer's instructions, which comes with the kit, to ensure an accurate test. A phone number is also included with the HIV self-test for anyone to call to get help with conducting the test. OraQuick's website also has a step-by-step video to guide users through the test.

Users should not eat, drink, or use oral care products before starting the test. They should put the test stick they swabbed their gums with into the test tube provided by the kit. Wait 20 minutes, and one line will appear on the test stick if you are negative. If two lines appear, that means HIV antibodies have been detected.

It’s important to take a follow-up test at a medical office to confirm the results. 

OraQuick is an antibody test, and it takes 23 to 90 days after an exposure for antibody tests to detect HIV.

The expected performance of the test is 92% test sensitivity, according to the OraQuick package. The FDA explains that this equates to one false-negative result out of every 12 test results in people who are HIV-positive. Clinical studies have found that OraQuick produces one false-positive out of every 5,000 tests. This is why it’s important to take another test at a medical office to confirm the diagnosis.

Autoimmune diseases like lupus may interfere with the results, and may incorrectly produce a false-positive.

Test Window and Accuracy 

If you get a negative result, it's important to remember that the test may not detect HIV up to three months after infection. You can only be sure you are truly HIV-negative if your most recent test was after the window period and you haven’t had a potential HIV exposure during the window period. If you have had a potential exposure, you will need to be retested.

Rapid Self-Test Basics

  • It can be purchased online or at a pharmacy to be taken at home or a private location
  • It requires an oral swab, and analysis is done using materials in the kit
  • It takes 20 minutes to get the results
  • It has 92% sensitivity

Point-of-Care Test

Point-of-care (POC) HIV testing also tests for HIV antibodies. It is conducted by a medical professional and provides quick results. While waiting for the results of their antibody test, people are counseled on their possible results.

Research has shown that those who get a standard HIV test like ELISA, a lab test that detects HIV antibodies and can take several days, in a medical setting often do not return to receive their results. Since POC testing provides results with little delay, those who want to get tested and receive their results quickly may feel more motivated to stay and wait.

POC Test Basics

  • It is performed at a clinic or healthcare provider's office
  • It requires a blood drop from a finger prick, an oral swab, or a urine sample, and the analysis is performed by a healthcare provider
  • It takes 20 minutes to get the results, and counseling will take place before and after the test
  • It has a 95.5% sensitivity

How the Test Is Performed

Point of care testing can be done in a hospital, urgent care clinic, or healthcare provider's office. POC testing typically requires a blood sample from a finger prick, plasma, urine, or oral fluid to test for HIV antibodies. Many healthcare professionals will use oral fluid sampling for children.

POC testing includes pre- and post-test counseling. Before the test, a healthcare provider will provide information on the test and evaluate the individual's likelihood of having HIV through risk screening, which means the healthcare provider will ask those getting the POC test about specific behaviors that may put them at increased risk of HIV.

Post-test counseling may look different for those who tested positive and those who tested negative. but for both groups, their healthcare provider will want to identify specific behaviors that are putting them at high risk of HIV infection and set goals to change those behaviors.

For those with a negative result, the counseling may include a discussion of the result and an explanation of what the window period is. Their healthcare provider may also schedule another appointment for HIV prevention counseling and talk about ways to prevent HIV infection. For those who are tested HIV-positive, their healthcare provider will schedule a confirmation test and discuss ways to reduce their risk of transmitting HIV or other sexually transmitted diseases to others. They may also schedule a follow-up appointment three to six months after the diagnosis is confirmed to see whether medical care has been initiated.

Test Window and Accuracy

The POC tests that use blood samples for testing have a sensitivity of 95.5%. One study found that most rapid antibody testing is similarly effective compared with standard testing, but rapid antibody tests that use oral fluid samples for testing have a much lower chance of detecting HIV.

If a POC test comes back negative, it could be the result of the fact that the patient is in their window period. They may be asked to take another test to confirm at the end of the window period. If the test is positive, the patient is also asked to take a confirmatory test, which is done through blood sampling and analysis at a lab. Results usually take one to two weeks to come back.

Pros and Cons

At Home (Rapid Self-Test)

  • Researchers found that at-home tests may empower people to manage their HIV risk and help them overcome the stigma of HIV. The privacy and ease of an at-home test make it more accessible to those who may not want to be seen entering a clinic.

  • At-home testing is becoming more popular with the introduction of at-home lyme disease tests and at-home sexually transmitted infection (STI) tests.

  • The CDC has found that the accuracy of rapid at-home test is low due to operator's lack of experience and mistakes. Studies have found that when trained personnel is administering the test, rapid testing has excellent performance.

  • Take-home tests can be dangerous for those who are HIV-positive and looking to reconfirm their status. If their test results come back as a false-negative, they may stop taking antiretroviral therapy. The World Health Organization has stated that people who are taking antiretroviral therapy should not take an rapid self-test. 

  • Those who take a test at home don't have an immediate and trusted resource, like a healthcare professional, to offer assistance during the testing process.

Point-of-Care Testing

  • Rapid POC testing gives patients resources and information they need while they wait for their test results, giving them a chance to learn more about HIV infection and risk reduction.

  • Going into a clinic or healthcare provider's office allows the patient to ask medical professionals who have accurate information on HIV questions and learn more about their status.

  • The sensitivity and accuracy of POC tests are higher than those of rapid self-tests.

  • POC tests, which are conducted by a healthcare professional, are more accurate and less likely to leave room for errors as rapid self-tests may.

  • Improper storage or sample collection can result in an inaccurate test result.

Interpreting Results

If your results come back as non-reactive, you are HIV-negative. That means you do not have the virus, or it could mean you were tested during your window period, or you had a false negative, especially given the relatively low sensitivity of a home test. Even if you were tested negative, that doesn't mean that your partner is also HIV-negative. Encourage everyone you've been intimate with to take a test.

It's imperative to understand that not every test will be 100% accurate.

Approximately 1.1 million people in the United States are living with HIV, and one in seven people aren't aware that they have the virus. If you think you've been exposed to HIV during the window period and your test was therefore inaccurate, you can get a laboratory test called the nucleic acid test (NAT), which requires a blood sample to be taken from a vein in the arm. The test has a smaller window period than an HIV antigen test (10 to 33 days), and can tell if a person has HIV or how much virus is present in the blood.

If your results come back reactive, that means the result is a possible positive. You will be required to take another test to confirm your diagnosis. The lab will use an NAT to confirm your results. If both of your tests are positive, then you are HIV-positive.

Knowing that you have HIV can be emotionally and mentally taxing. Remember that while HIV is not curable, it can be managed with treatments like antiretroviral therapy. The FDA had approved 43 different antiretroviral drugs by 2017, with new treatments being manufactured every day. These drugs can keep HIV under control and help those with HIV live a long, healthy life.

A Word From Verywell

Rapid self-tests and point-of-care testing may cut down the amount of time it takes to find out if you have HIV, but the process can still be stressful and scary. One way or another, finding out quickly can give you peace of mind because you will know whether you have been exposed to the virus. It's important to remember that even if you do test positive or negative for HIV through one of these tests, you will still need to confirm that result with another test.

Whether you test positive or negative, you should take actions that will reduce your risk of HIV infection or transmission to others. If you do test positive, an HIV diagnosis may be life-changing, but there are treatments available to help manage the virus so you can continue living your life. Joining a support group or seeking help from a mental health professional may help you better cope with this diagnosis.

Seek out a counselor or therapist to offer support and answer questions you may have. If you need immediate help, call the 24-hour toll free HIV hotline to find a counselor in your state. Visit HIV.gov locator to find a provider close to you. 

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By S. Nicole Lane
S. Nicole Lane is a freelance health journalist focusing on sexual health and LGBTQ wellness. She is also the editorial associate for the Chicago Reader.