Increased HIV testing and reduced undiagnosed infection among gay men in Scotland, 2005-8: support for the opt-out testing policy?

Abstract

ObjectiveTo examine changes in HIV testing and undiagnosed infection among men who have sex with men in Scotland between 2005 and 2008.MethodsSelf-completed questionnaires and Orasure oral fluid collection kits were distributed to men visiting the commercial gay scene in Glasgow and Edinburgh.ResultsQuestionnaires and oral fluid specimens were provided by 1350 men (51.6% response rate) in 2005 and 1277 (59.7% response rate) in 2008. 2572 men were eligible for inclusion in the analyses. Recent HIV testing increased from 33.2% in 2005 to 48.3% in 2008 (p<0.001). HIV prevalence was comparable in 2005 and 2008 (4.4% and 4.6%, respectively). Among HIV-positive men, there was a reduction in undiagnosed infection between 2005 and 2008 from 41.7% to 26.3% (p=0.08). Undiagnosed HIV did not differ between men who were and were not tested in the past year. In 2008, only four (26.7%) HIV-positive men tested in the past 6 months were undiagnosed, compared with 11 (42.3%) HIV-positive men who had not tested (p=0.03).ConclusionThere was a substantial increase in recent HIV testing between 2005 and 2008. Although there was a concurrent (non-significant) reduction in undiagnosed HIV, there was no difference in undiagnosed infection between men who had and had not tested recently. However, lower proportions of undiagnosed infection among the most recent HIV-positive testers suggest frequent testing could play a role in reducing undiagnosed HIV and should remain central to HIV prevention efforts.

Active recall to increase HIV and STI testing: a systematic review

“…Repeat testing among MSM has been associated with a history of STIs, higher number of sexual partners, having oral or unprotected insertive anal sex, and knowing someone with HIV infection 42 44. In this review, non-reattenders in response to recall were more likely to be HIV-positive,31 in keeping with studies that have compared sexual risk among those that test for HIV compared with those that do not 31 45 46…”

Audit of HIV testing frequency and behavioural interventions for men who have sex with men: policy and practice in sexual health clinics in England

“…However, despite guidance for more frequent HIV testing,25 the little evidence there is on the acceptability, feasibility and effectiveness of increased recall frequency is conflicting 11 26 27. Therefore, further studies are required to determine optimal frequency of HIV testing 27…”

“…National audits examined the proportion of MSM offered and taking up an HIV test,9 10 and surveys have investigated the association between recent HIV testing and HIV infection 11. To our knowledge, there has been no national analysis of frequency of HIV testing or characterisation of behavioural interventions offered in SH clinics.…”

Late HIV presentation: epidemiology, clinical implications and management

“…This may, in part, be explained by a lack of consistency between the HIV testing guidelines and national guidelines for the specialties involved [95]; for example, UK guidelines for the management of peripheral neuropathy do not mention HIV testing even though HIV guidelines name this as a clinical indicator for testing [211]. However, there have been some successes -a Scottish study of MSM testing rates showed significant increases from 2005 to 2008 in those ever tested (60.8 to 74.6%) and those tested in the last 12 months (34 to 48.3%) [97], and UK surveillance data shows a small increase in diagnoses made in primary and acute medical services. The possibility of consenting all surgical patients to point-of-care HIV testing in the case of needlestick injury to staff has also been raised in a recent paper [98].…”