Background:
Philadelphia's categorical STD clinic is the largest single HIV test site in the city, with an average of 8,740 HIV tests performed per year over the past 5 years. The rapid HIV test (Oraquick Rapid HIV-1 Antibody Test), from which results can be read in 20 minutes, became available in this clinic in 2004, but its cost was higher than for conventional antibody testing.

Objective:
To describe changes in HIV testing demand and testing follow-up activities after introducing routine rapid HIV testing in a large urban STD clinic.

Method:
Two one-year periods were selected for analysis. In one (period 1), antibody testing was used exclusively and in the other (period 2), HIV rapid testing was used exclusively. Period 1 was compared to period 2 in terms of the number of clinic patients who agreed to HIV testing, the number of people presenting for anonymous testing, the number of persons with HIV identified, and the ability to link those testing positive to care.

Result:
Preliminary data show that the number of anonymous tests increased from 966 to 1,768 and the number of confidential tests increased from 6,837 to 8,560 between period 1 and period 2, yet the number of positives remained stable. During period 1, 10 (1.0 %) persons who were anonymously tested never returned for their test results, while all persons testing positive during period 2 were given their test results and were offered referral to care. The average time to referral for care decreased from 14 days to 1 day between period 1 and period 2.

Conclusion:
The implementation of rapid HIV testing led to an increase in testing and an improvement in follow-up, but the number of persons identified with HIV did not significantly increase.

Implications:
Rapid HIV testing in an STD clinic can significantly increase the demand for testing and associated services.