Aim: To provide a method of testing for HIV that addressed some of the barriers to testing
Barriers according to LSHTM: Expenditure of time and energy making appointments and waiting times Stigma associated with attending STI clinics Discomfort with clinical procedures (swabs, needles etc.) The possibility of judgemental staff.
Reasons for not testing (GMFA survey) 62.3% I didn’t think I had put myself at risk of HIV 24.6% I was too busy / it wasn’t convenient 21.3% I was scared I might find out I had HIV 9.8% I didn’t think about it 9.8% No reason, I just didn’t.
Solution: A home sampling service for MSM. Launched November 2012 Collaboration between: Homerton Hospital GMFA DrThom City & Hackney PCT / later HPE
Process: MSM complete an online sexual risk assessment MSM order a test from Dr Thom site Testing kits usually sent out the next day MSM take a saliva sample and post the sample back Get a text if the sample is non-reactive Get a call from Homerton if the sample is reactive
Risk Assessment 2,034 logged onto the survey 950 people excluded (not MSM / London resident) 1,354 began actual risk assessment 1,328 finished risk assessment
Risk Assessment results 45.5% of respondents < 30 58.5% white British 40% tested in the last year 5.7% last tested more than 5 years ago 21.1% never tested
Reasons for ordering a test 37.6% I haven’t tested in a while & feel I should 22% I test on a regular basis 22% I’ve had anal sex without a condom 6.3% I have a partner & we want to stop using condoms 5.6% I’ve had a condom break or slip off
Last UAI 6.8% within the last 72 hours 33.2% 0-14 weeks 29% 14 weeks + (beyond window period) 11% Before my last HIV test 20.1% No UAI or condom failure.
Ordering kits 897 people ordered kits (67% of those who finished the risk assessment) 153 (17%) orders unconfirmed 743 kits dispatched 72.7% of kits returned for analysis 8 samples reactive
Evaluation of service MSM who completed the process and received a negative result were asked to complete an evaluation.
How easy or difficult was it ordering the test online? Very easy70 (83.3%) Easy12 (14.3%) Neither easy nor difficult2 (2.4%) Difficult0 Very difficult0 Don’t know0
When the test arrived, was it what you were expecting? Yes77 (91.7%) No5 (6%) Not sure2 (2.4%)
How easy or difficult was taking the saliva sample? Very easy63 (75%) Easy19 (22.6%) Neither Easy nor Difficult2 (2.4%) Difficult0 Very Difficult0 Don’t know 0
How comfortable or uncomfortable were you with receiving your result by text? Very comfortable65 (78.3%) Comfortable12 (14.5%) Neither / nor uncomfortable4 (4.8%) Uncomfortable0 Very uncomfortable1 (1.2%) Don’t know1 (1.2%)
Would you use the service again? Yes81 (96.4%) No2 (2.4%) Not sure1 (1.2%)
How likely are you to recommend our testing service to a friend if they needed to test? Extremely likely65 (79.3%) Likely12 (14.6%) Neither Likely nor unlikely1 (1.2%) Unlikely4 (4.9%) Extremely unlikely0 Don’t know0
Would testing at home make it more or less likely that you test for HIV at least once a year? Extremely likely68 (81%) Likely12 (14.3%) Neither Likely nor unlikely2 (2.4%) Unlikely1 (1.2%) Extremely unlikely0 Don’t know1 (1.2%)
In the future where would you prefer to have an HIV test? At home76 (91.6%) At a GUM clinic6 (7.2%) At a GP0 At a pharmacy / chemist0 In a community setting0 (e.g. a sauna, a gay club / pub, Pride etc.) I don’t have a preference1 (1.2%)