RESUMEN
HIV self-testing (HIVST) introduces opportunities for screening in non-conventional settings, and addresses known testing barriers. This study involved the development and evaluation of a free online HIVST dissemination service hosted by a peer-led, community-based organisation with on-site, peer-facilitated HIV testing, and established referral and support programs for people newly diagnosed with HIV to determine whether this model was feasible and acceptable for engaging MSM, particularly among infrequent and naive HIV-testers, or those living in remote and rural areas. Between December 2016 and April 2018, 927 kits were ordered by 794 individuals, the majority of whom were men who have sex with men (MSM) (62%; 494), having condomless sex (50%; 392), or living outside a major city (38%; 305). Very few (5%; 39) sought the available pre-test peer contact, despite 45% (353) being naive HIV-testers. This study demonstrates that online HIVST dissemination is acceptable and feasible for engaging at-risk suboptimal testers, including those unwilling to test elsewhere (19%; 47/225). With half (50%; 403) unwilling to buy a kit, our study suggests that HIVST will need to be subsidized (cost-neutral to users) to enhance population coverage and access.
Asunto(s)
Infecciones por VIH , Minorías Sexuales y de Género , Australia/epidemiología , Femenino , Infecciones por VIH/diagnóstico , Infecciones por VIH/epidemiología , Homosexualidad Masculina , Humanos , Masculino , Tamizaje Masivo , Autocuidado , AutoevaluaciónAsunto(s)
Infecciones por Chlamydia/diagnóstico , Chlamydia/genética , Gonorrea/diagnóstico , Técnicas de Diagnóstico Molecular/normas , Neisseria gonorrhoeae/genética , Faringe/microbiología , Sistemas de Atención de Punto/normas , Recto/microbiología , Infecciones por Chlamydia/orina , Gonorrea/orina , Humanos , Técnicas de Diagnóstico Molecular/métodos , Sistemas de Atención de Punto/estadística & datos numéricos , Sensibilidad y EspecificidadRESUMEN
Background The advent of fully automated nucleic acid amplification test (NAAT) technology brings new public health opportunities to provide Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) point-of-care testing (POCT) in non-traditional settings. METHODS: This pilot study evaluated the integration of the CT/NG Xpert diagnostic assay into an urban peer-led community setting providing HIV and syphilis POCT. A comprehensive protocol of testing, result notification, referral and follow up, managed by peer test facilitators, was undertaken. RESULTS: Over 67 weeks, there were 4523 occasions of CT/NG testing using urine, oropharyngeal and anorectal samples with 25.7% (803) of the 3123 unique participants returning for repeat testing. The prevalence of CT and NG was 9.5% and 5.4% respectively. Where CT and or NG infection was detected, 98.4% (604/614) of participants were successfully notified of detected infection and referred for treatment. Evaluation Survey responses (11.4%, 516/4523) indicated a substantial proportion of respondents (27.1%, 140/516) 'would not have tested anywhere else'. Of note, 17.8% (92/516) of participants reported no previous CT/NG test and an additional 17.8% (92/516) reported testing more than 12 months ago. A total of 95.9% (495/516) of participants 'Strongly agreed' or 'Agreed' to being satisfied with the service. CONCLUSION: The project successfully demonstrated an acceptable and feasible model for a peer-delivered community-led service to provide targeted molecular CT/NG POCT. This model offers capacity to move beyond the traditional pathology and STI testing services and establish community-led models that build trust and increase testing rates for key populations of epidemiological significance.
Asunto(s)
Infecciones por Chlamydia/diagnóstico , Chlamydia trachomatis , Centros Comunitarios de Salud , Gonorrea/diagnóstico , Neisseria gonorrhoeae , Técnicas de Amplificación de Ácido Nucleico/métodos , Pruebas en el Punto de Atención , Adulto , Australia/epidemiología , Estudios Transversales , Femenino , Humanos , Masculino , Aceptación de la Atención de Salud , Satisfacción del Paciente , Proyectos Piloto , Población UrbanaRESUMEN
Background The aim of this study was to compare the performance of pooled self-collected urogenital, pharyngeal and anorectal specimens to that of individual specimen results for the molecular detection of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) near the point of care (POC) for diagnostic sensitivity. METHODS: Clients (mostly men who have sex with men) attending an urban community testing service and three sex-on-premises venues in Brisbane, Australia, were offered CT and NG testing by trained lay providers. Participants provided three self-collected specimens (urine, pharyngeal and rectal) for testing by GeneXpert (Cepheid, Sunnyvale, CA, USA). If any of the individual specimens from a participant were positive, all three specimens were pooled and retested. RESULTS: Of the 388 participants who provided three individual anatomical specimens, 76 (19.6%) were found to be positive for CT and/or NG at one or more sites. The pooling approach failed to detect five CT rectal and four NG pharyngeal infections. The overall performance (sensitivity) of the pooling approach compared with individual specimen testing and Cohen's κ were 90.0% and 0.86 respectively for CT and 89.7% and 0.89 respectively for NG. CONCLUSIONS: Reduced sensitivity was observed when using pooled specimens for the detection of CT and NG using GeneXpert near the POC, similar to results reported in laboratory-based CT and NG pooling studies. These data suggest specimen pooling is feasible near to the POC, potentially saving time and costs when screening at-risk populations for CT and NG. Our data also suggest a reduction in pooled urine could improve overall test sensitivity.
Asunto(s)
Infecciones por Chlamydia/diagnóstico , Infecciones por Chlamydia/orina , Gonorrea/diagnóstico , Gonorrea/orina , Homosexualidad Masculina/estadística & datos numéricos , Tamizaje Masivo/métodos , Técnicas de Amplificación de Ácido Nucleico/métodos , Manejo de Especímenes/métodos , Adulto , Anciano , Anciano de 80 o más Años , Australia , Chlamydia trachomatis/aislamiento & purificación , Humanos , Masculino , Persona de Mediana Edad , Neisseria gonorrhoeae/aislamiento & purificación , Enfermedades Faríngeas/microbiología , Sistemas de Atención de Punto , Enfermedades del Recto/microbiología , Sensibilidad y EspecificidadRESUMEN
The aim of this study was to establish 'proof of concept' for a novel approach to HIV and STI testing at a sex on premises venue (SOPV) for gay and bisexual and other men who have sex with men (GBMSM) during late night group sex theme parties. A mixed-methods approach was used, and the study aimed to: (1) Build upon existing SOPV funded service delivery and establish 'proof of concept' for this unique setting within an SOPV; (2) evaluate the uptake and feasibility/acceptability of routine HIV/STI testing for GBMSM during theme parties in SOPV; and (3) identify beliefs/perceptions regarding this health promotion activity and venue suitability. The characteristics of patrons utilising PoCT (Point of Care Testing) were established to help further reach potentially stigmatised, highly sexually adventurous GBMSM. The findings support further PoCT endeavours within MSM communities to target harder to reach communities to reduce the rate of new transmissions of HIV. Findings can inform future health promotion, screening and interventions, as well as to identify a successful method to engage harder to reach GBMSM that need further focused targeting for HIV and STI testing to reduce transmission.
Asunto(s)
Bisexualidad , Infecciones por VIH/diagnóstico , Homosexualidad Masculina , Aceptación de la Atención de Salud , Pruebas en el Punto de Atención/organización & administración , Enfermedades de Transmisión Sexual/diagnóstico , Adolescente , Adulto , Anciano , Coito , Estudios de Factibilidad , Infecciones por VIH/prevención & control , Promoción de la Salud/métodos , Humanos , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Grupo Paritario , Desarrollo de Programa , Conducta Sexual , Enfermedades de Transmisión Sexual/prevención & control , EstereotipoRESUMEN
BACKGROUND: Innovative health promotion strategies are needed to improve access to HIV testing among regional people in Australia, particularly for men who have sex with men (MSM). This project aimed to establish proof of concept for point-of-care-testing (POCT) via a mobile van clinic at community 'beat' locations. Surveys evaluated client satisfaction, characteristics and testing preferences among 'early adopters'. Sequential mixed-methods approach was used which included secondary qualitative analysis of field notes written by peer-testers (i.e., trained lay providers from the key population being targeted; to extend the contextualise the pilot evaluation), documenting barriers/facilitators and innovations, per action research and to guide recommendations for future health promotion initiatives. METHODS: A POCT 'proof of concept' project (2, 3-hourly sessions/week; 20 weeks) was delivered in a regional town by peer-testers using a mobile clinic van, recruited by geosocial 'apps' targeting MSM. Clients completed surveys regarding demographics, and testing satisfaction, frequency and preferences. Peer-testers completed detailed field notes for each session including client characteristics and impressions, salient events, concerns and recommendations. RESULTS: The program resulted in 34 online health promotion conversations with MSM and 34 POCT tests (19 HIV, 15 Syphilis; 18 unique client visits; 17 identified as MSM, with 1 heterosexual female. Rates of satisfaction among early adopters of POCT was high. Analysis of field notes revealed three major themes: 1) Practical challenges; 2) Barriers to engagement; and 3) Recruitment method/project promotion. CONCLUSIONS: Amongst early adopters satisfaction was high, with 47% of clients reported infrequent testing (over 12 months ago) or having 'never tested'. No tests were reactive. Challenges associated with this health promotion initiative and recommendations for future HIV testing promotion and programs were outlined.
Asunto(s)
Promoción de la Salud/métodos , Homosexualidad Masculina , Pruebas en el Punto de Atención , Enfermedades de Transmisión Sexual/diagnóstico , Adulto , Anciano , Australia , Humanos , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Prueba de Estudio Conceptual , Enfermedades de Transmisión Sexual/epidemiología , Adulto JovenRESUMEN
This study aims to pilot and evaluate an integrated model for HIV self-testing (HIVST) service delivery in a peer-led Queensland community setting to increase access to HIVST, particularly for men who have sex with men (MSM) living in regional, remote and rural areas. It seeks to provide evidence that would overcome some of the key objections previously raised to HIVST. Recruitment strategies have been designed to engage hard to reach MSM populations in testing. Awareness of the trial will be generated through advertising on social media platforms, including dating applications, word of mouth and HIV related websites. Participants will access an HIVST online ordering system hosted by a HIV community organisation. This system: (1) enables on-line informed consent; 2) gives clients the choice to accept verbal pre-test information from a trained peer test facilitator or not; and (3) allows for ordering of the HIVST kit after completion of an online survey (with demographic information and testing history etc.). Clients receive the kits via the post; and at 2 weeks receive a follow-up phone-call and SMS link to a post-test survey. If the test is non-reactive, clients can opt for test reminders. If reactive, referral to clinical services, peer navigation and support systems are provided. This study addresses important gaps in understanding of acceptable and feasible methods to integrate HIVST into an existing peer-led testing service and into the broader suite of HIV testing options and services. The findings will inform the actions needed to enhance access to HIVST for MSM wishing to use this technology in Australia and elsewhere, especially those who have never tested and infrequent testers.
Asunto(s)
Serodiagnóstico del SIDA , Accesibilidad a los Servicios de Salud , Servicios de Salud Rural , Autocuidado , Minorías Sexuales y de Género , Adolescente , Adulto , Publicidad , Femenino , Homosexualidad Masculina , Humanos , Internet , Relaciones Interpersonales , Masculino , Proyectos Piloto , Desarrollo de Programa , Queensland , Proyectos de Investigación , Encuestas y Cuestionarios , Adulto JovenRESUMEN
This paper explores the willingness to use and pay for HIV Self-testing (HIVST) among Australian gay and bisexual men (GBM). Bivariate and univariate multinominal logistic regression of data from an online survey was performed. Thirty-one (13%) had never HIV tested and 41.9% (88) were testing sub-optimally by Australian guidelines. Half (58.4%, 136) had never heard of HIVST, however, 56.2% (131) reported willingness to use HIVST, with sub-optimal (OR=2.13; p < 0.01) and never-testers (OR=2.01; p < 0.10) significantly more likely to do so than optimal-testers. Most were confident (51.7%, 119) or somewhat confident (29.1%, 67) accessing support following a reactive result, however, never-testers were significantly less confident compared to previous testers (OR=3.47; p< 0.05). Less than a quarter (23.6%, 57) were willing to pay for a kit with AUD$15 (R2 = 0.9882) the estimated preferred price. This research confirms that HIVST is an important and accepted adjunct to established HIV testing modalities, particularly among sub-optimal and never-testers and that online (61.6%, 143) or clinic-based (61.6%, 143) dissemination are preferred. Research examining how best to disseminate HIVST in a range of safe and effective models needs to continue to ensure HIVST is part of a comprehensive strategy that facilitates usage and linkages to care.
Asunto(s)
Serodiagnóstico del SIDA/estadística & datos numéricos , Infecciones por VIH/diagnóstico , Conocimientos, Actitudes y Práctica en Salud , Autocuidado , Minorías Sexuales y de Género , Adolescente , Adulto , Australia , Bisexualidad , Estudios Transversales , Necesidades y Demandas de Servicios de Salud/estadística & datos numéricos , Homosexualidad Masculina , Humanos , Masculino , Persona de Mediana Edad , Aceptación de la Atención de Salud/estadística & datos numéricos , Encuestas y Cuestionarios , Adulto JovenRESUMEN
The landscape of HIV testing has changed significantly in recent years following the rise in importance of the 'treatment as prevention' strategy and advancements in new HIV testing and prevention technologies. This review provides a synthesis of qualitative research findings published since 2010 on preferences and practices of men who have sex with men (MSM) surrounding HIV testing in high-income settings. MSM are one of the hardest groups to reach with standard or conventional HIV testing approaches. To develop innovative testing strategies for this particular group, a good understanding of their concerns, barriers and facilitators of accessing HIV testing is needed. This updated review provides valuable information for improving existing programs and designing new testing services for MSM.
Asunto(s)
Infecciones por VIH/diagnóstico , Infecciones por VIH/psicología , Homosexualidad Masculina , Tamizaje Masivo/métodos , Parejas Sexuales , Adulto , Infecciones por VIH/prevención & control , Homosexualidad Masculina/psicología , Humanos , Masculino , Investigación Cualitativa , Pruebas Serológicas , Parejas Sexuales/psicología , Estigma SocialRESUMEN
BACKGROUND: The success of 'treatment as prevention' (TasP) to control HIV relies on the uptake of testing across priority population groups. Innovative strategies including; rapid HIV testing (RHT) in community and outreach settings, engaging peer service providers, and not requiring disclosure of sexual history have been designed to increase access. This paper reports on the implementation of 'RAPID', a community-based testing program in Queensland, Australia that employs these strategies to increase access to testing. METHODS: Service data, including client registration forms and a satisfaction survey from all clients attending RAPID between August 2014 and July 2015 were analysed. RESULTS: In 2014/2015 1,199 people attended RAPID to receive a free HIV test. The majority were urban-based gay men. 17.1% were first-time testers and 20.1% of participants were not eligible to access Medicare, Australia's universal health care scheme. CONCLUSIONS: RAPID's evidence-based strategies appear to facilitate access to HIV testing, particularly among those who have never tested before; however the implications for the ongoing treatment and care of people ineligible for Medicare, who test positive to HIV warrants careful consideration.