1. HIV TESTING WITHOUT THE FULL Q&A
Lemoire J1, Debattista J2, Mutch A3, Dean J3, Lui C3, Whittaker A4, Mao L5, Fitzgerald L3
1Queensland Positive People, 2Metro North Public Health Unit, 3School of Public Health, University of Queensland, 4Anthropology at the School of Social Sciences, Monash University,5Centre for Social Research in Health, University of New South Wales
Background
Early diagnosis and initiation of antiretroviral therapy (ART) is a key global HIV prevention strategy that relies on extensive uptake and regular engagement of target populations in HIV testing.1
Rapid HIV testing (RHT) technology reaches people who have never been tested or test infrequently, increases the number of people who receive their test results, and links those who have a positive result to care, particularly among marginalised at-risk groups. 2,3,4
Queensland Context
Queensland’s HIV incidence has continued to increase in recent years
The predominant transmission mode remains sexual contact between men
Estimates show between 4,262 to 4,932 people are living with HIV with 20 to 30% unaware they are positive.5
RAPID►► RHT Program
A Point of Care RHT trial conducted as a partnership between Queensland Positive People, HIV Foundation Queensland and Queensland Health opened in August 2014.
Offers free rapid HIV & syphilis testing performed by trained peers who also provide health education about PEP, PrEP and ongoing HIV & STI testing during the 20minute wait for results.
Testing occurs at a comfortable, convenient central Brisbane city location and the Gold Coast with opportunistic testing at outreach to four Sex on Premises Venues (SOPV).
The aim is to engage MSM to test for HIV without the need to disclose risk behaviours, a known barrier to testing6 & then refer to GPs or sexual health services for ongoing STI/HIV testing & care.
Method
All RAPID►► RHT Program attendees are asked to complete a survey including items exploring demographic profile (e.g., gender, sexuality, postcode), frequency of testing, reason for testing, along with questions relating to service preferences and satisfaction.
Descriptive and correlational statistics were conducted to evaluate if the RAPID►► RHT program is meeting the trial aim of increasing HIV testing among those people disengaged from established HIV testing models.
Table 1 Client characteristics
All RAPID Clients
(N=1483)
SOPV Clients
(n=298)
Never tested
(n=191)
Tested positive
(n=21)
Age Mean
Range
Years  35
17-83 44
18-78 31
19-70 %
% (n)
Gender Male
Female
Transgender
96.2
3.7 .1
99.7 .3 11 89
1.4 (21)
Indigenous
2.2
1.7
1.1
Sexuality Gay
Straight
Bi-sexual
77.4
13.8
8.7
84.9
2.7
12.4
54.5
30.4
15.1
90.4 (19)
4.8 (1)
Medicare ineligible
18.5
16.1
29.8
(6)
Country of Birth
Australia NZ UK
USA
China
India
Other
60.9
3.2
4.2
2.3
24.3
66.8 4 1
1.3
29.5
50.2
2.6
5.2
10.5
6.3
46.6
47.6 (10)
9.5 (2)
(4)
Residential location
South East Qld
Rural
Interstate
93.4
2.9
3.6
88.6
5.5
5.9 90
71.4 (15)
Repeat RAPID Clients 20
17.1
Note: % may not add to 100 and numbers may not add to total due to rounding up and missing data
Results
From Aug to July 2015 RAPID►► tested 1438 people from a range of backgrounds (See Table 1) for a range of reasons. (See Diagram 1)
Majority heard about RAPID►► from dating apps (25%) or recommendations for others (23%) (See Diagram 2)
1.4% (21) of all clients and 1.3% of SOPV patrons had a reactive RHT test. (See Table 2)
8.6% of the 240 Syphilis tests done were reactive
9.5% of the 21 reactive RHT were also reactive for syphilis.
Majority (88%) were strongly satisfied with the service.
82% reported RHT affected how often they tested.
93% were ‘much more likely’ or ‘more likely’ to use a peer based service.
41.5% found RHT much less stressful compared to conventional HIV blood tests. (See Diagram 3)
Diagram 1 Reasons for HIV test
Diagram 2 Heard about RAPID►► service
Conclusion & Implications for Practice
RAPID►► has been a successful addition to the established network of HIV testing models in QLD.
The Peer model offers a different testing experience that when combined with SOPV outreach increases testing among previous non and infrequent testers and Medicare ineligible people.
Discreet testing opportunities encourages some MSM to test for HIV, however, ongoing research is needed to inform service and health promotion planning.
Diagram 3 Stress level with RHT test
Table 2 Testing patterns
All RAPID Clients
(N=1483)
SOPV Clients
(n=298)
Never tested
(n=191)
Tested positive
(n=21)
Frequency of testing
At least once a year
A year or more ago
Never %
63.8
22.5
13.7  %
58.9
28.2
12.9 n
191
n %
(19%)
Reactive HIV test
1.4% (21)
1.3% (4)
21 (1.4%)
Reactive Syphilis test
8.6% (21) 1
2 (9.5%)
References
Kretzschmar, et al.(2013). Prospects of elimination of HIV with test-and-treat strategy. Proceedings Of The National Academy Of Sciences Of The United States Of America, 110(39),
Broeckaert, L., & Challacombe, L. (2015). Rapid point-of-care HIV testing: A review of the evidence. Toronto.
Holt, M. (2009). Rapid HIV Testing: A Literature Review. Newtown, NSW, Australia: Australian Federation of AIDS Organisations.
Pottie, K, et al.. (2014). Effect of rapid HIV testing on HIV incidence and services in populations at high risk for HIV exposure: An equity-focused systematic review. BMJ Open, 4(12). Queensland Government, (2014).
Queensland HIV Strategy Brisbane.
Jones, Jeb, et al. "Acceptability and willingness among men who have sex with men (MSM) to use a tablet-based HIV risk assessment in a clinical setting."SpringerPlus 3.1 (2014): 708
Acknowledgements: The authors acknowledge the clients and staff at RAPID Disclosure of Interest: This study was funded by the HIV Foundation Queensland Research Grant Correspondence: Lisa Fitzgerald, School of Public Health, Faculty of Medicine and Biomedical Sciences, The University of Queensland, Public Health Building, 288 Herston Road, Herston QLD P: Published: 28/8/2015