1. HIV Self-Sampling: Establishing a sustainable service
Dr Anthony Nardone
Centre for Infectious Disease Surveillance and Control

2. Outline Background: Results form national services Proposed next steps
HIV epidemiology
What is HIV self-sampling
PHE support
Results form national services
Volumes of requests
Dependence on health promotion work
Profile of users
Linkage into care
Satisfaction of service
Proposed next steps

3. Background
An estimated 1 in 5 people living with HIV are undiagnosed (22,000)
An estimated 6,500 (29%) of undiagnosed in London
HIV epidemiology in 2012 :
47% of new HIV diagnosed with CD4 count <350
~½ of MSM diagnosed at first HIV test
Two populations most at-risk of HIV
Men who have sex with men (MSM)
Black-Africans
Need to increase HIV testing and frequency of testing, especially among MSM

4. Background (2) HIV Self Sampling:
person takes a sample (saliva or blood from a finger prick), and sends it to a laboratory for testing.
Results are then given by the service, advising you what to do next
HIV Self Testing:
Person performs an HIV test on themselves, in a non-medical setting (e.g. home), and sees a result immediately
6th April: Repeal of the HIV testing and Services Regulations
hpa.org.uk/webc/HPAwebFile/HPAweb_C/

5. HIV Self-Sampling Services
HIV tests ordered on-line
4th generation dried blood spot
3rd generation oral swab
Samples posted to laboratory
Individual informed of result
Negatives by text
Positives by phone and letter
Referral to HIV service recommended
The service offered dried blood-spot kits to communities with the highest prevalence of undiagnosed HIV infection in England:
Men who have sex with men (MSM)
Black African heterosexuals

6. Results from 2nd phase support
PHE has supported two services for 5 months of operation (Nov 13 – March 14) which has delivered:
12,485 test requests
6,593 returned (53%)
92 new diagnoses (1.4% positivity)
Major issues highlighted from pilot phases
High volumes that can be managed through the internet
Different to clinic populations (younger and more rural)
Used by those at high risk due to testing and sexual behaviour
Linked to care
User satisfaction

7. Self sampling kits delivered in West Midlands
In 5 months (Nov 13 – Mar 14), 2 national services have delivered:
12791 kits delivered, 1089 to the West Midlands

8. Relationship to marketing (Phase 2)
National HIV testing week
Brady M et al BHIVA/BASHH conference 2014

9. Geo-demography of users (MSM)

10. Self-reported HIV testing history
33%
41%
25%
MSM
Black African Heterosexuals

11. Sexual partners in last year and testing history, MSM
MSM reporting more sexual partners tested more recently (χ2=123.80, p< 0.001).
This self-sampling service facilitates access to testing for a population of MSM who are already testing. As it is recommended that these individuals test up to quarterly intervals, this method of providing HIV testing will alleviate burden on GUM clinics whilst allowing men who need to test frequently to do so conveniently.
(n=1088)
(n=1350)
(n=832)

12. Confirmed attendance at HIV service (%)
Access to care (Phase 1)
Brady M et al BHIVA/BASHH conference 2014
Outcome
Number
Confirmed attendance at HIV service (%)
Accepted referral to HIV service 38
32 (84.2)
Self referral to HIV service 46
33 (71.7)
Already known to be positive and accessing care 11
11 (100)
Declined further contact/failed to respond to messages 8 1
Living abroad (Spain/Zambia) 2
N/A
Total
105
77 (74.7)

13. User Satisfaction with the National HIV Self-Sampling Services
HPE/THT (N=861)
Dean Street (N=229)
Would you recommend the service to a friend expected to test negative
97%
96%
Would you recommend the service to a friend expected to test positive
65%
58%
I would use the service again -
“I was really grateful that this existed as I don't think I would have gone to a clinic. I would have taken a lot of courage. an anonymous postal service made it so much easier. I would be really happy if this existed for other sexual health screening.”
McOwan et al BASHH/BHIVA conference 2014

14. Conclusion Successful self-sampling pilots:
Large volumes with high return and positivity rates
~¾ users had either never tested before or insufficiently
Closely linked to health promotion activity
Accessing Black African populations remains a challenge
Costs much lower than clinic or outreach based services
Major contribution to plans to increase HIV testing
Adjunct to HIV testing in clinical services
Platform to which other STI tests could in future included

15. Acknowledgments:
Michael Brady and colleagues at Terrence Higgins Trusts /HIV Prevention England Alan McOwan and colleagues at Dean Street Clinic/Chelsea & Westminster Hospital NHS Foundation Trust