A novel time-limited pop-up HIV testing service for gay men in Sydney, Australia, attracts high-risk men
Vickie Knight A B G , Marianne Gale C , Rebecca Guy B , Nicolas Parkhill D , Jo Holden C , Craig Leeman E , Anna McNulty A F , Phillip Keen B and Handan Wand BA Sydney Sexual Health Centre, South East Sydney Local Health District, PO Box 1614, Sydney, NSW 2001, Australia.
B The Kirby Institute, Wallace Wurth Building, UNSW Australia, Sydney, NSW 2052, Australia.
C NSW Ministry of Health, Sydney, NSW 2060, Australia.
D ACON, 414 Elizabeth Street, Surry Hills, NSW 2010, Australia.
E SydPath St Vincent’s Hospital Sydney Limited, Darlinghurst, NSW 2010, Australia.
F School of Public Health and Community Medicine, UNSW Australia, Kensington, NSW 2052, Australia.
G Corresponding author. Email: Vickie.knight@sesiahs.health.nsw.gov.au
Sexual Health 11(4) 345-350 https://doi.org/10.1071/SH14091
Submitted: 22 May 2014 Accepted: 22 July 2014 Published: 28 August 2014
Abstract
Background: HIV diagnoses have been increasing steadily in Australia and are concentrated among gay, bisexual and other men who have sex with men (GBM). HIV testing is a key control strategy, and in 2013, a novel time-limited pop-up community HIV testing service (Pop-up) was introduced to raise awareness and increase testing options for GBM. The Pop-up service offered rapid HIV tests only. We compared uptake and outcomes of the Pop-up service to an established clinical model [a fast-track screening service in a sexual health clinic offering rapid and/or conventional HIV tests and sexually transmissible infection (STI) tests]. Methods: Service delivery data was collated and analysed from the HIV Pop-up (25 November to 1 December 2013) and the fast-track HIV/STI screening service (Xpress) in a sexual health clinic immediately before the Pop-up (1 August to 22 November 2013). A comparison of all the HIV tests and results, tests per hour and characteristics of new clients (demographics, risk behaviour, testing history) was conducted using χ2, Poisson distribution and Ranksum tests. Results: At the Pop-up service, 182 GBM had a rapid HIV test conducted over the 5-day period (average: seven HIV tests per hour) and no HIV tests were reactive (0%, 95% confidence interval: 0–1.8%). At the Xpress service, 1075 asymptomatic GBM had at least one STI test and 957 GMB had a HIV test (rapid or conventional) conducted over the 3-month period (average: four HIV tests per hour), with two positive HIV tests (0.2%, 95% confidence interval: 0.02–0.7) and 151 positive STI tests (14%, 95% confidence interval: 12–16.2). Compared with new patients at the Xpress service, GBM attending the Pop-up service were older (median of 39 vs 29 years, P < 0.01); more likely to report ≥5 sexual partners in the past 3 months (P = 0.02); more likely to reside in ‘Gay Sydney’ (P < 0.01); and more likely to be tested for HIV (P < 0.01). Conclusions: Time-limited Pop-up community HIV testing is feasible and reached high-risk GBM, but compared with a clinic-based model, it only reached a smaller proportion of GBM who test infrequently or who have never been tested and are unaware of their HIV status. No STI testing was conducted through the Pop-up service, which allowed a higher throughput of HIV tests; however, a significant number of STIs may have been missed.
References
[1] Grulich AE, Kaldor JM. Trends in HIV incidence in homosexual men in developed countries. Sex Health 2008; 5 113–8.| Trends in HIV incidence in homosexual men in developed countries.Crossref | GoogleScholarGoogle Scholar | 18588775PubMed |
[2] The Kirby Institute. HIV, viral hepatitis and sexually transmissible infections in Australia. Annual Surveillance Report 2013. Sydney: The Kirby Institute; 2013.
[3] NSW Health Communicable Diseases Branch. New diagnoses of HIV infection, NSW, 2012. Sydney: Ministry of Health; 2013. Available online at: http://www.health.nsw.gov.au/Infectious/hiv/Documents/2012-hiv-summary.pdf [verified 5 February 2014].
[4] Bourne C, Edwards B, Shaw M, Gowers A, Rodgers C, Ferson M. Sexually transmissible infection testing guidelines for men who have sex with men. Sex Health 2008; 5 189–91.
| Sexually transmissible infection testing guidelines for men who have sex with men.Crossref | GoogleScholarGoogle Scholar | 18588782PubMed |
[5] STIs in Gay Men Action Group. Australian STI and HIV testing guidelines 2014 for asymptomatic men who have sex with men. Sydney: STIGMA; 2014. Available online at: http://stipu.nsw.gov.au/wp-content/uploads/STIGMA_Testing_Guidelines_Final_v5.pdf [verified 31 July 2014].
[6] Holt M, Mao L, Prestage G, Zablotska I, deWit J. Gay community periodic surveys: national report 2010. Sydney: National Centre in HIV Social Research, The University of New South Wales; 2011.
[7] Guy R, Goller JL, Spelman T, El-Hayek C, Gold J, Lim M,, et al Does the frequency of HIV and STI testing among men who have sex with men in primary care adhere with Australian guidelines? Sex Transm Infect 2010; 86 371–6.
| Does the frequency of HIV and STI testing among men who have sex with men in primary care adhere with Australian guidelines?Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC3cflsVyjug%3D%3D&md5=4225b874ddc4566fe81494f7d34339a1CAS | 20460263PubMed |
[8] Jansson J, Kerr CC, Wilson DP. Predicting the population impact of increased HIV testing and treatment in Australia. Sex Health 2014; 11 146–54.
| 24502838PubMed |
[9] Prestage G, McCann PD, Hurley M, Bradley J, Down I, Brown G. PASH: Pleasure and sexual health. Sydney: National Centre in HIV Epidemiology and Clinical Research; 2010.
[10] Madeddu D, Grulich AE, Richters J, Ferris J, Grierson J, Smith A, et al Estimating population distribution and HIV prevalence among homosexual and bisexual men. Sex Health 2006; 3 37–43.
| Estimating population distribution and HIV prevalence among homosexual and bisexual men.Crossref | GoogleScholarGoogle Scholar | 16607973PubMed |
[11] Australasian Society for HIV Medicine (ASHM). ASHM trained HIV s100 prescribers listed by state by suburb. Sydney: ASHM; 2014. Available online at: http://www.ashm.org.au/images/prescriber/ashmprescribers.pdf [verified 11 May 2014].
[12] Conway DP, Holt M, McNulty A, Couldwell DL, Smith DE, Davies SC, et al Multi-centre evaluation of the determine HIV combo assay when used for point of care testing in a high risk clinic-based population [correction published in PLoS ONE 2014; 9: e103399]. PLoS ONE 2014; 9 e94062
| Multi-centre evaluation of the determine HIV combo assay when used for point of care testing in a high risk clinic-based population [correction published in PLoS ONE 2014; 9: e103399].Crossref | GoogleScholarGoogle Scholar | 24714441PubMed |
[13] Beelaert G, Fransen K. Evaluation of a rapid and simple fourth-generation HIV screening assay for qualitative detection of HIV p24 antigen and/or antibodies to HIV-1 and HIV-2. J Virol Methods 2010; 168 218–22.
| Evaluation of a rapid and simple fourth-generation HIV screening assay for qualitative detection of HIV p24 antigen and/or antibodies to HIV-1 and HIV-2.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC3cXptlWktb0%3D&md5=475a7f382a134d0795a7f19bffcc5237CAS | 20561542PubMed |
[14] Pavie J, Rachline A, Loze B, Niedbalski L, Delaugerre C, Laforgerie E, et al Sensitivity of five rapid HIV tests on oral fluid or finger-stick whole blood: a real-time comparison in a healthcare setting. PLoS ONE 2010; 5 e11581
| Sensitivity of five rapid HIV tests on oral fluid or finger-stick whole blood: a real-time comparison in a healthcare setting.Crossref | GoogleScholarGoogle Scholar | 20657834PubMed |
[15] Rosenberg NE, Kamanga G, Phiri S, Nsona D, Pettifor A, Rutstein SE,, et al Detection of acute HIV infection: a field evaluation of the Determine® HIV-1/2 Ag/Ab Combo test. J Infect Dis 2012; 205 528–34.
| Detection of acute HIV infection: a field evaluation of the Determine® HIV-1/2 Ag/Ab Combo test.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC38XhslOqu7c%3D&md5=ccbc0e89ae3b5ac528605b2c67f30e27CAS | 22207651PubMed |
[16] Jones CB, Kuldanek K, Muir D, Phekoo K, Black A, Sacks R, et al Clinical evaluation of the Determine HIV-1/2 Ag/Ab Combo test. J Infect Dis 2012; 206 1947–9.
| Clinical evaluation of the Determine HIV-1/2 Ag/Ab Combo test.Crossref | GoogleScholarGoogle Scholar | 23045627PubMed |
[17] Knight V, Ryder N, Guy R, Lu H, Wand H, McNulty A. New Xpress sexually transmissible infection screening clinic improves patient journey and clinic capacity at a large sexual health clinic. Sex Transm Dis 2013; 40 75–80.
| New Xpress sexually transmissible infection screening clinic improves patient journey and clinic capacity at a large sexual health clinic.Crossref | GoogleScholarGoogle Scholar | 23250305PubMed |
[18] Keen P, Conway DP, Cunningham P, McNulty A, Couldwell DL, Davies SC, et al. Performance of the Trinity Biotech Uni-Gold HIV 1/2 Rapid Test as a first-line screening assay for gay and bisexual men. National Sexual Health Conference; 9–11 October 2014; Sydney, Australia. Sydney: ASHM; 2014.
[19] Holt M, Hull P, Lea T, Guy R, Bourne C, Prestage G, et al Comprehensive testing for, and diagnosis of, sexually transmissible infections among Australian gay and bisexual men: findings from repeated, cross-sectional behavioural surveillance, 2003–2012. Sex Transm Infect 2014; 90 208–15.
| Comprehensive testing for, and diagnosis of, sexually transmissible infections among Australian gay and bisexual men: findings from repeated, cross-sectional behavioural surveillance, 2003–2012.Crossref | GoogleScholarGoogle Scholar | 24234070PubMed |
[20] Fernández-Balbuena S, de la Fuente L, Hoyos J, Rosales-Statkus ME, Barrio G, Belza MJ, Madrid Rapid HIV Testing Group. Highly visible street-based HIV rapid testing: is it an attractive option for a previously untested population? A cross-sectional study. Sex Transm Infect 2014; 90 112–8.
| Highly visible street-based HIV rapid testing: is it an attractive option for a previously untested population? A cross-sectional study.Crossref | GoogleScholarGoogle Scholar | 24234073PubMed |
[21] Conway D, Guy R, Davies S, Couldwell D, McNulty A, Smith D, et al. Rapid HIV testing is acceptable and preferred among gay men attending sexual health clinics: findings from the Sydney rapid testing study. Australasian HIV/AIDS Conference; 17–19 October 2012; Melbourne, Australia. Sydney: ASHM; 2012.
[22] Couldwell D, Biggs K, Townsend J, Conway D, Keen P, Holt M, et al. Reasons why men who have sex with men decline rapid HIV testing. ASHM National HIV conference; 21–23 October 2013; Darwin, Australia. Sydney: ASHM; 2013.
[23] Bernstein KT, Marcus JL, Nieri G, Philip SS, Klausner JD. Rectal gonorrhea and chlamydia reinfection is associated with increased risk of HIV seroconversion. J Acquir Immune Defic Syndr 2010; 53 537–43.
| Rectal gonorrhea and chlamydia reinfection is associated with increased risk of HIV seroconversion.Crossref | GoogleScholarGoogle Scholar | 19935075PubMed |
[24] Wilson D, Hoare A, Regan D, Wand H, Law M. Mathematical models to investigate recent trends in HIV notifications among men who have had sex with men in Australia. Sydney: University of NSW, National Centre in HIV Epidemiology and Clinical Research; 2008.
[25] Martin L, Knight V, Read PJ, McNulty A. Fast-track services for all? The preferences of Chinese, Korean and Thai-speaking women attending a sexual health service. Sex Transm Dis 2013; 40 929–32.
| Fast-track services for all? The preferences of Chinese, Korean and Thai-speaking women attending a sexual health service.Crossref | GoogleScholarGoogle Scholar | 24220353PubMed |
