Testing begins at home

It used to be that the simple thermometer was the sum total of the typical American family's home-health gadgets.

But today there's a whole new world out there in the rapidly expanding marketplace of health-related home test kits. And yes, we're all used to seeing the early pregnancy kits, glucose strips for diabetics and cholesterol monitoring tests.

Now, however, the consumer can purchase such things as DNA paternity tests, teen drug testing kits, keychain breathalyzers and, most recently, HIV testing kits. All these are available online and many can be purchased at the local drugstore with no age requirements involved.

"The machines themselves, the actual testing devices, are quite accurate," said Dr. Michael Brandt, PharmD, pharmacy clinical supervisor at Kootenai Health. "They must meet very, very stringent criteria as defined by the FDA (Food and Drug Administration). The tests themselves, in a controlled environment, are quite accurate - as accurate as in a hospital or a physician's office.

"Directions are included in the package, but we know in the medical community that many people don't follow directions completely and that this can negatively affect the outcome of the test."

It's understandable why these over-the-counter tests are popular. They're less expensive than a doctor visit, cheaper than a major league lab test and the results can be dealt with in the privacy of one's home.

But how effectively, exactly, do we deal with those results?

Kelly Jo Hillyard is supervisor of the Juvenile Diversion Program for Kootenai County and, on the issue of parents testing their children for drug use, she said, "I think anytime you can hold a kid accountable and keep them honest - checking to make sure what they're saying is true - it probably won't keep the kids off drugs, but it will definitely be used as a deterrent.

"I think where we do get into trouble with this kind of testing is if the parent does get a positive reading and they don't know what the next step should be. Our community has some fantastic support services for this, such as school counselors and the Juvenile Diversion Program."

Reviews from medical personnel on the increasing use of home testing devices have been mixed.

"I think there's one part of at-home testing that's great and that's the fact that people are taking responsibility for their health," said Dr. Leanne Rousseau, a family medicine physician at Kootenai Clinic. "I think the technology is good and most of the devices are accurate.

"But say you do your own HIV test, it's definitely important to get follow-up and counseling on your results. In our clinics, we don't even do HIV tests without counseling."

The off-the-shelf HIV test is a relative newcomer to the health lineup. Sam Haddad, PharmD at the Coeur d'Alene Walgreens confirmed that the store does sell the test - it must be requested at the pharmacy counter, however - and that there is no minimum age requirement for purchasing it.

Stacie Lechot, a licensed social worker and executive director of the North Idaho Aids Coalition, said the two most important things the AIDS Coalition recommends are learning your HIV status and making the connection to care.

"So, if at-home kits get people tested, that's great," she said. "What I'm worried about is the 'connection to care' piece - the piece that says, 'What do I do next?'

"If you came to us for testing, you would have a trained counselor in front of you to tell you what to do next. This includes, among other things, confirming you haven't gotten a false reactive. We're also going to talk about what it means to be HIV positive and we'll hook you up with a great team of HIV providers.

"That's the kind of thing that's missing in that test kit box you get at the store. That and other things such as information on the importance of partner notification and the Idaho state law about infecting others."

Rousseau agrees. "The HIV test can be 99 percent accurate, so in one sense it's a positive thing that people being responsible for their health," she said. "My concern, though, is that the results may either panic people or lull them into a false sense of complacency. What the results should do is trigger a visit to a provider for further testing."

Some of the do-it-yourself tests are so chic you can hang them on your keychain. Take, for example, the personal breathalyzer. The goal of this gadget is to allow drinkers to measure their level of inebriation before getting into a car.

"I think that's a phenomenal idea. If it's going to prevent any alcohol-related car accidents, I'm all for it," Brandt said.

But how do these results stack up in accuracy against those of the breathalyzers used by police and troopers?

According to Jeremy Johnston, Volatiles Analysis Discipline Leader for Idaho State Police, ISP devices are held to rigid quality assurance/quality control standards. Within 24 hours of being used in a test, the breathalyzer must have its calibration checked.

"The problems with the keychain ones," he said, "are that they'll sit in a drawer for months and then people will use them and have no idea how accurate they are. Without the proper testing equipment, I don't know how a person outside of law enforcement would check to make sure those instruments are giving accurate results.

"The one thing you should look for in any breath testing device is whether or not it is listed on the USDOT (United States Department of Transportation) conforming products list."

Rousseau advised conducting a similar check for at-home health tests. "I would recommend that people get online and see if their testing devices are FDA approved," she said.

In the end, the general consensus is that at-home testing may, indeed, provide valuable information about the state of your health. It is advised, however, that once you have your results in hand, you contact a health professional to obtain the most accurate interpretation of those results.