Background North Rhine-Westphalia is the federal state with the highest number of HIV infections in Germany. The Landeszentrum Gesundheit (lzg.nrw) organises and supports anonymous HIV testing by 53 local public health authorities (LPHA). Aim of this study was to assess if offering additional rapid testing in the LPHA could attract hard-to-reach risk groups to HIV testing.

Methods After counselling, 24 LPHA offered their clients a rapid assay (RA; Vikia HIV 1/2, bioMérieux) alternatively to routine testing by a 4^th generation HIV test (chemiluminiscent microparticle immunoassay, CMIA, Abbott) in a private laboratory (Labor Krone, Bad Salzuflen). Reactive tests were confirmed by immunoblot analysis and/or RT-PCR.

Results In 2011–2012, 24,623 clients were tested by CMIA in all 53 LPHA and 21,513 by RA in 24 LPHA. Among clients tested by CMIA there were 48.8% women, 50.5% men, median age was 31 years, 12.9% were men who have sex with men (MSM), 13.2% female sex workers (FSW). Among RA clients there were 39.2% female, 60.5% male, 73.9% belong to the age range of 20–39 years, 13.9% MSM, 0.7% FSW. In the CMIA, 1.2% of the samples were reactive versus 0.6% in RA. Overall, 0.8% of LPHA clients were confirmed HIV-positive. Specificity was high (> 99.8%) for both tests. Four early infections could only be detected by CMIA and confirmed by RT-PCR whereas RA and immunoblot analysis were still negative.

Discussion Approximately half of the LPHA in NRW offered their clients the RA. Clients deciding for RA were slightly different according to age, gender, risk behaviour and HIV status. It could not be shown so far that by offering RAs the LPHA attracted special risk groups which might otherwise not have been tested for HIV. It needs to be considered that some early HIV infections could be detected by CMIA but not by RA.