Sex Transm Infect 88:218-221 doi:10.1136/sextrans-2011-050131
  • Health services research
  • Original article

Supervised blood-based self-sample collection and rapid test performance: a valuable alternative to the use of saliva by HIV testing programmes with no medical or nursing staff

  1. the Madrid Rapid HIV testing Group*
  1. 1Escuela Nacional de Sanidad. Instituto de Salud Carlos III, Madrid, Spain
  2. 2CIBER Epidemiología y Salud Pública (CIBERESP), Spain
  3. 3Servicio de Medicina Preventiva. Hospital Central de la Cruz Roja San José y Santa Adela, Madrid, Spain
  4. 4Servicio de Medicina Preventiva. Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
  5. 5Centro Nacional de Epidemiología. Instituto de Salud Carlos III, Madrid, Spain
  1. Correspondence to Juan Hoyos, Escuela Nacional de Sanidad. Instituto de Salud Carlos III. C/Sinesio Delgado, 8. 28029 Madrid, Spain; jhoyos{at}
  1. Contributors MJB, LdlF and MER-S designed the study and wrote the protocol. MJB and LdlF took overall responsibility for the project. EF, PS, RS, GM and the Madrid Rapid HIV testing Group made contributions to the study design, data collection tools, pilot study and participated in the acquisition of data. MER-S and JH took part in the acquisition of data and did the analysis and interpretation of data. MJB and MER-S wrote the manuscript. LdlF critically revised the manuscript and contributed important intellectual content. All authors reviewed, edited and approved the manuscript. All authors had full access to all the data in the study and can take responsibility for the integrity of that data and the accuracy of the data analysis.

  • Accepted 17 January 2012
  • Published Online First 11 February 2012


Objectives Some saliva-based HIV testing programmes have resulted in an unacceptable percentage of false positives. Many countries require blood-based testing programmes to have doctors/nurses. The authors evaluate whether, after brief training and under the supervision of a skilled counsellor, blood-based self-sample collection and rapid test performance could be a valuable alternative.

Methods 208 Spanish-speaking attendees at a street-based HIV testing programme in Madrid participated in the study. Participants were tested twice, first in the study and then in the programme, using the same finger-stick whole-blood rapid test (Determine HIV-1/2 Ag/Ab Combo®). Based on previously adapted instructions, the study counsellor explained the procedure to follow throughout the test. Participants then performed the test under the guidance of the counsellor. Demographic and risk behaviour data were collected by a self-administered questionnaire. The test results in the programme and the study were read by the study counsellor.

Results 99.0% (95% CI 96.6% to 99.9%) of participants had a valid result in the study test, the same percentage as in the programme test conducted by the doctor/nurse. Two persons had invalid test results in both the study and the programme, but they were not the same persons.

Conclusion The study provides clear evidence that this methodology is a valuable alternative to saliva for HIV testing programmes when medical or nursing staff required to take blood samples is not available.


  • * Madrid Rapid HIV testing Group: Jorge Álvarez, Óscar Ayala, María J Bravo, Jorge Gutiérrez, Mónica Ruiz, José Pulido, Sara Santos, Sonia Fernández-Balbuena.

  • Funding This study was funded by Fondo de Investigación Sanitaria (FIS:PI09/9074) and Fundación para la Investigación y Prevención del Sida en España (FIPSE/36634/07).

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval The Ethics approval was provided by the institutional review board of the Instituto de Salud Carlos III (approval number: CEI PI 16_2009).

  • Provenance and peer review Not commissioned; externally peer reviewed.