CLINICS AND COMMUNITY Dr Mags Portman

Where does prevention sit in a clinical context? Day to day working Routine HIV testing in clinical setting Motivational Interviewing and Behavioural Intervention Safer sex and Harm reduction Part of clinic strategy Finding those most at risk and tailoring services to them Educating other clinicians Promoting rapid & repeat test offer (AWARE RCT) Host organisation Promoting staff know their HIV status at health events etc Roadshows/screensavers to promote HIV testing in patients Local health pathway ‘how to test’ pathways & materials Part of local Sexual Health and HIV strategy National HIV Testing Week Evaluating new technologies eg. Self-testing kits; dried blood spots

How, when & where can we implement routine HIV testing? Traditional settings (GUM, antenatal, TOP) Other hospital settings (Hepatology, Oncology, Colposcopy, TB clinics, general medical admissions, A&E) “Pop Up” clinics at events for MaRPs Supporting GPs in high prevalence areas to offer testing Within 3rd sector organisations Outreach – “working together” clinic & community ie) saunas, churches, street-based mobile health units Working with Public Health to understand areas of greatest need Sexual Health websites (postal kits)

How can we bring clinicians and community together to support each other in our common aims? Our Story Leeds Centre for Sexual Health Hosted coordination meetings, ideas, volunteers, training sessions Leeds Contraception and Sexual Health (CaSH) volunteers, hosted sessions Leeds City Council support, promotion Yorkshire MESMAC outreach (incl online), engaged local clubs and bars, provided sessions BHA Skyline engaged new African community venues, provided sessions, volunteers, outreach in City Centre Dec 2012 Y&H data Leeds becomes only high HIV prevalence area in Y&H ?2.14/1000

Leeds NHTW 2013 - Results All sessions took place in community venues; African community/gay bars and clubs Collected more data - wanted to know if we were accessing people not testing via traditional sexual health clinics Word of mouth/outreach or the presence of testers in a venue proved the most effective way of recruiting. 31% of MSM learnt of testing via the internet Tested over 70 people per day at GUM clinic

Leeds NHTW 2013 - Results 126 people tested 90 (71%) from MARPS (2012 - 94 tested, 51% MARPs) 61(48%) MSM, with 5 reporting sex with men and women 27 (21%) Black African (16 male) There were no HIV positive results >95% of people tested were given advice on PEP, repeat testing, STI screening and offered condoms

Leeds NHTW 2013 - Results MSM Black Africans 40% had never tested for HIV 63% had never tested, or tested >12/12 ago 68% did not know about PEP 54% had never attended GUM Of those who recalled being seen in GUM, none had been seen in the preceding year Black Africans 15% had never tested for HIV 63% had never tested or >12/12 ago 81% did not know about PEP 64% had never attended GUM

Leeds NHTW 2013 - Media Talk about the H&Wbeing board/DPH event at time when SH service out to tender & real threat of SH-HIV service fragmentation etc

Leeds NHTW 2013 – Learning Points Start organising earlier – NHTW is for life, not just a week in Nov! More advertising and media involvement earlier Collect data regarding venues and numbers attending to focus efforts next year Those with experience of outreach achieved higher testing numbers NHTW provides a platform for ongoing testing Much closer relationships between clinic and community organisations