Just thinking aloud for #medtwitter and #researchtwitter...

tl;dr New HIV testing algorithm and technology needed for people who inject drugs (PWID) and cannot provide a blood sample a for lab based 4th gen confirmatory test for PrEP initiation or continued maintenance. 1/

Currently, the study that I’m working on has numerous long term PWIDs. Most have no veins left in their arms, hands, or feet from which to draw blood. Multiple sticks at multiple, unconventional sites are required to obtain one tube of blood to be sent to the lab. 2/

The repeated sticks SUCK, not only for the study participant, but for the the phlebotomists who hate having to hurt folks. We’ve had a handful of participants stop PrEP because they fear the blood draw aspect of their visit.

THESE FOLKS COULD BENEFIT GREATLY FROM PrEP! 3/

But because our current testing algorithm requires a rapid test (at initiation), *and* a confirmatory lab based sample, we lose SO MANY of our most vulnerable folks without providing them PrEP. For some people the blood draw is a huge barrier to care. 4/

I get why the confirmatory test is important, and I also get that the technology for a better rapid test just isn’t there yet. I’m asking for a solution to this that makes use of what we currently have while maximizing the number of people we can get on PrEP. 5/

Ideas for future R&D: a sensitive finger stick rapid HIV test that will take the place of the lab based confirmatory one AND a re-work of the current testing algorithm to allow for more PrEP initiations among PWID who cannot provide enough blood. 6/

We’re leaving people out and keeping them at risk by sticking to outdated testing algorithms. We need to think outside the box.

/End rant.