Testing history and risk behaviour of individuals requesting an HIV test through an online self-sampling service SJ Westrop 1, C James 2, D Edwardes 2, M Brady 2, R Gillespie 2, ON Gill 1 and A Nardone 1 1 Public Health England and 2 Terrence Higgins Trust

Background 98,400 people living with HIV in the UK 1 o 1 in 5 people living with HIV (21,900) unaware of their infection 1 Increasing HIV testing is a major component of HIV prevention; by reducing number of undiagnosed HIV disproportionally affects: o men who have sex with men (MSM): ~1 in 20 1 o black African heterosexual men: ~1 in 38 1 o black African heterosexual women: ~1 in 20 1 Current recommendations for frequency of testing are: o MSM: at least once every 12 months, or every 3 months if having unprotected sex with new or casual partners o black African men and women: test if having unprotected sex with new or casual partners 1 HIV in the United Kingdom: 2013 report. Public Health England

Service provision HIV tests ordered on-line 4 th generation dried blood spot HIV test Samples posted to PHE lab Negative results by text Reactive results by phone Referral by THT to HIV service recommended Consent for follow up to confirm access to care

Service provision Individuals request kit from internet HIV Self-Sampling Service Management web site (incl. marketing) Fulfilment Pathology Results Management Local campaignsMedia Campaigns National campaigns

Study aims and objectives Aim To describe the users of the HIV self-sampling service, in order to evaluate the effectiveness of reaching target populations by investigating: Testing history High-risk sexual behaviour

Methods National service; Jan-Sep 2013 and Nov 2013-Mar ,629 ordered; 10,410 returned (59.0%); 146 positive (1.4%) Collected extra data from 3522 requests 16 day period from 27-Feb-14 to 14-Mar-14 Clients ordering kits provided: o Demographic information; ethnicity, gender, sexuality o HIV testing information; time since last HIV test o Sexual behaviour information; number of sexual partners, unprotected sexual partners, frequency of sex under the influence of alcohol or drugs Pearson's χ 2 test determined associations

Target groups black African heterosexuals n=58n=79 Heterosexual men Heterosexual women 88% 85%

Target groups men who have sex with men SexualityNumberProportion Bisexual man3409.7% MSM 94.3% Gay man % Heterosexual1373.9% Lesbian10.0% Rather not say401.1% Missing230.7% TOTAL3522

Testing history men who have sex with men n= % 41% 25%

Testing history black African heterosexuals n=112 40% 47% 13%

Sexual partners past 12 months 80% 65% 54% n=3270n=49n=63

Sexual partners and testing history men who have sex with men Total n=3270 χ 2 =123.80, p< (n=1088) (n=1350)(n=832)

Sexual partners and testing history black African heterosexual women Total n=63 χ 2 =17.57, p= (n=25) (n=37)(n=7)

Conclusion Self-sampling service enables large numbers from target populations to test quickly and easily Significant proportions of clients had never tested before o black African heterosexual women with more sexual partners had not tested as recently; higher risk not accessing testing o MSM with more sexual partners had tested more recently; more convenient to use self-sampling service The self-sampling service represents a novel, effective method of expanding HIV testing to individuals at high-risk of infection, who otherwise may not test

Acknowledgements PHE Laboratory Manchester Dave Ellis Ken Mutton Terrence Higgins Trust Fizza Qureshi Emmanuel Buenaventura Service users