Feasibility and acceptability of point of care HIV testing in community outreach and GUM drop-in services in the North West of England: A programmatic evaluation

Abstract

BackgroundIn Liverpool, injecting drug users (IDUs), men-who-have-sex-with-men (MSM) and UK Africans experience a disproportionate burden of HIV, yet services do not reach out to these groups and late presentations continue. We set out to: increase testing uptake in targeted marginalized groups through a community and genitourinary medicine (GUM)-based point of care testing (POCT) programme; and conduct a process evaluation to examine service provider inputs and document service user perceptions of the programme.MethodsMixed quantitative, qualitative and process evaluation methods were used. Service providers were trained to use fourth generation rapid antibody/antigen HIV tests. Existing outreach services incorporated POCT into routine practice. Clients completed a semi-structured questionnaire and focus group discussions (FGDs) were held with service providers.ResultsBetween September 2009 and June 2010, 953 individuals underwent POCT (GUM: 556 [59%]; community-based sites: 397 [42%]). Participants in the community were more likely to be male (p = 0.028), older (p < 0.001), of UK African origin (p < 0.001) and IDUs (p < 0.001) than participants from the GUM clinic. Seventeen new HIV diagnoses were confirmed (prevalence = 1.8%), 16 of whom were in risk exposure categories (prevalence: 16/517, 3.1%). Questionnaires and FGDs showed that clients and service providers were supportive of POCT, highlighting benefits of reaching out to marginalised communities and incorporating HIV prevention messages.ConclusionsCommunity and GUM clinic-based POCT for HIV was feasible and acceptable to clients and service providers in a low prevalence setting. It successfully reached target groups, many of whom would not have otherwise tested. We recommend POCT be considered among strategies to increase the uptake of HIV testing among groups who are currently underserved.

The role of Point-of-Care testing in the diagnosis of syphilis

“…New HIV and syphilis cases were then diagnosed and linked to treatment and care. The same was found by MacPherson et al [54] in injecting-drug users (IDUs), MSM, and UK Africans, who successfully reached these target groups, many of whom would not have been tested otherwise. Studies performed in Bangalore, India, and the Amazon region of Brazil [22,44,55,56] showed that POCT was helpful in alleviating the impact of syphilis in both pregnant and non-pregnant outreach populations, including high-risk individuals such as sex workers.…”

“…Lately, it seems that this may be overcome with the availability of treponemal and non-treponemal POC tests that may be used successfully in areas with unfavourable conditions for a normal diagnostic laboratory. Overall, these tests have shown to have good sensitivities and specificities [30,32,33,47] and to increase screening in different population groups from pregnant women to sex workers, MSM and drug addicts, and other outreach populations anywhere in the world [22,25,44,[54][55][56]. The tests are generally well received by local health care workers and clients in places where studies have been performed [24,25,40,49,56].…”

“…POCT is generally well accepted by clients and health professionals to diagnose either HIV or syphilis, as demonstrated in Lima, Peru [57]; Manaus, Brazil [56]; India [40]; Kenya [58]; Tanzania [49,59]; China; Uganda; Zambia [49]; Canada [27]; and England [54]. Clients were satisfied in receiving the test results rapidly in the first visit [24,49], with no need to come back for results.…”

2016 United Kingdom national guideline on the sexual health care of men who have sex with men

“…Intensive peer counselling also increased the uptake of testing (22). Alternative community venues (200) are used for on-site testing including gay saunas (201), event-related outreach (40), and college-based testing (202). Offering other tests (eg for STIs, alcohol or drug use) along with HIV testing may increase uptake in some groups of MSM (203).…”

Effect of testing experience and profession on provider acceptability of rapid HIV testing after implementation in public sexual health clinics in Sydney

“…In contrast, RHT involves finger-prick blood or oral fluid specimen collection with results provided during the same visit, which may make testing more convenient. Barriers to implementing RHT reported among service providers include: lack of time [12,13]; lack of confidence in their own competency and skills and fear of delivering positive results [14,15]; concern regarding reliability and false positive results [16,17]; and perceiving RHT as too difficult for nonexperts [18].Although many studies have assessed acceptability of RHT in a variety of settings and patient groups, and among providers at various stages of implementation [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28], few studies have assessed differences in acceptability between professions [29,30]. To our knowledge, no published studies have examined if the number of tests performed and experience of false test results impact on provider acceptability.…”