Community HIV testing for men who have sex with men (MSM) Will it decrease undiagnosed infection? Jonathan Roberts Liaison Health Adviser Brighton & Sussex University Hospitals NHS Trust

Background Sexual Health Strategy (2001)  undiagnosed HIV by 25% by 2007 Unlinked anonymous surveys 26% MSM remain undiagnosed nationally 1 33% in Brighton 2 Increase demand on traditional GUM services DH funded program ( ) to evaluate community based HIV testing Sites in London, Brighton & Birmingham Specific target groups: MSM & Africans 1. HPA (2004) 2. Sexual health survey of gay men (2004). J Dodds. UCL

Methods Brighton Started October 2004 Hosted & promoted by THT Targeted MSM at high risk through “You Choose” website Weekly open access clinic 6:30pm – 8:30pm Nurse/Health Advisor led service 10 clients each week x

Methods Brighton Started October 2004 Hosted & promoted by THT Targeted MSM at high risk through gay media & outreach Weekly open access clinic 6:30pm – 8:30pm Nurse/Health Advisor led service 10 clients each week

Rapid HIV test Abbott determine HIV 1&2 test kit –£12 per test –only detects antibody, not p24 antigen –less sensitive in early HIV infection Sensitivity 100%; specificity 99.9% Positive men –immediate confirmatory sample to lab. –fast tracked GUM clinic

Evaluation Sigma Research Self-complete 4 page questionnaire for all FasTest users –demographics –previous use of GUM, testing history, sexual behaviour –why they chose FasTest –monitoring of follow-up through GUM & HIV services Similar questionnaire completed by Gay men accessing “traditional” GUM services

Results & demographics 338 HIV tests in 316 testers over 14 months 294 evaluation forms returned (net response rate 93.4%) Of these 280 in target group (MSM) –median age 33 years (range ys) –82.7% resident in Brighton (95.2% resident in SHA) –77.1% white British (96.0% white) 3.2% (9/280) HIV positive –all had positive confirmatory HIV tests –3 had never tested, 4 tested negative >1 year ago, 1 tested negative in last 12 months, 1 did not answer

Why FasTest? “because the test result was available at the same visit” (49.4%) “it was more convenient to come here” (36%) “difficulty making appointment with GUM” (15.6%) “I don’t know where else to test” (9.8%) “because friends recommend it” (9.8%)

Prior use of sexual health services & HIV testing history 16.6% had never had STI screen Of those who had (83.4%) –85.3% GUM / sexual health clinic –5.1% GP / local doctor –5.5% private health care 23.7% never previously tested for HIV –significantly younger, more likely to identify as bisexual, fewer partners in last year Reason for never testing –41.1% “been too afraid of result being positive” –17.9% “didn’t know where to go”

Community vs clinic testers: risk behaviour Community testers (n=278) Clinic testers (n=191) P value Median age (range) 33 (18-73) 34 (18-71)NS Never had STI screen 16.6% 12.7%NS Never previously tested for HIV 23.7% 14.7%0.016 New male partner last 3/ % 71.2%NS More than 12 partners last 12/ % 34.4% NS Sex with HIV positive partner last 12/ % 21.6% NS UPAI last 12/ % 68.4% NS * No differences in ethnicity, education, or sexuality

Community vs clinic testers: HIV positive pts Community testers (n=9) Clinic testers (n=17) P value Percentage HIV + 3.2% (9/278) 9.1% (17/187) CD4 cells/mm 3 (range) 311 (7 – 528) 431 ( ) NS Viral load (range) 31,000 (1, ,000,000) 131,779 (6,133 -3,781,755) NS Recent infection 3/9 (33%) 8/17 (47%) NS Other STIs 4/9 (44%) 10/17 (59%) NS STIs identified 2 chlamydia, 2 GC, 1 hepatitis C, 1 syphilis 7 chlamydia, 2 syphilis, 1 GC, 1 HSV

Conclusions (1) FasTest clinic reached a high risk population –high rates UPAI, HIV positive partners, multiple partners FasTest clinic more acceptable to a proportion MSM –result available same visit, more convenient Higher proportion in FasTest clinic had never tested for HIV More HIV diagnosed in GUM –GP referrals with seroconversion, more symptomatic patients, patients diagnosed as a result of contact tracing –all patients diagnosed with HIV attended for follow-up No increase in detection early infection

Conclusions (2) For those attending GUM, high rates of other STIs detected Cost effectiveness: £135 per HIV test compared to PbR tarif £142 Should investment in “traditional” GUM services take priority? Nevertheless, offers important alternative to GUM services May contribute to decreasing undiagnosed HIV infection Good example of partnership working

Community testers –were LESS likely to have ever tested for HIV and had tested less recently if they ever had –MORE likely to expect a POSITIVE HIV result (6.8% vs 2.7%)… but LESS likely to receive one (3.2% v 8.9%) Comparison of community testers with clinic testers

Acknowledgements Co-authors –Gillian Dean, Peter Weatherburn, Ford Hickson, Perry French, Alan Phillips, Martin Fisher Sigma Research Terrence Higgins Trust South staff and volunteers (Lee Dodge) Department of Health