Trial and error: evaluating and refining a community model of HIV testing in Australia

Abstract

BackgroundThe 2012 regulatory approval of HIV rapid point of care (RPOC) tests in Australia and a national strategic focus on HIV testing provided a catalyst for implementation of non-clinical HIV testing service models. PRONTO! opened in 2013 as a two-year trial delivering peer-led community-based HIV RPOC tests targeting gay, bisexual and other men who have sex with men (GBM), with the aim of increasing HIV testing frequency. Initial data suggested this aim was not achieved and, as part of a broader service evaluation, we sought to explore client acceptability and barriers to testing at PRONTO! to refine the service model.MethodsWe present descriptive and thematic analyses of data from two in-depth evaluation surveys and four focus groups with PRONTO! clients focused on service acceptability, client testing history, intentions to test and barriers to testing for HIV and other sexually transmitted infections (STIs).ResultsThe three novel aspects of the PRONTO! model, testing environment, rapid-testing, peer-staff, were reported to be highly acceptable among survey and focus group participants. Focus group discussions revealed that the PRONTO! model reduced anxiety associated with HIV testing and created a comfortable environment conducive to discussing sexual risk and health. However, an absence of STI testing at PRONTO!, driven by restrictions on medical subsidies for STI testing and limited funds available at the service level created a barrier to HIV testing. An overwhelming majority of PRONTO! clients reported usually testing for STIs alongside HIV and most reported plans to seek STI testing after testing for HIV at PRONTO!. When deciding where, when and what to test for, clients reported balancing convenience and relative risk and consequences for each infection as guiding their decision-making.ConclusionsA community-based and peer-led HIV testing model reduced previously reported barriers to HIV testing, while introducing new barriers. The absence of STI testing at PRONTO! and the need to access multiple services for comprehensive sexual health screening, created a significant service engagement barrier for some clients. Understanding client motivations to access testing and ensuring novel service models meet client needs is crucial for developing acceptable sexual health services for high-risk populations.

Community-based HIV testing in The Netherlands: experiences of lay providers and end users at a rapid HIV test checkpoint

“…An Australian study on a non-clinical HIV service testing called, PRONTO! showed that end users seemed to prefer doctors or nurses when compared to lay providers [ 31 ]. This may indicate that lay providers’ involvement is accepted by clients, but does not have to be the decisive factor to choose for AHF-Checkpoint.…”

A comparative, retrospective analysis of HIV testing among gay, bisexual and other men who have sex with men in Melbourne, Australia

“…at all due to the lack of STI testing, previous surveys of clients also indicated ongoing HIV testing at PRONTO! alongside intermittent HIV testing elsewhere 31 . Intermittent testing at PRONTO!…”

“…may have attenuated some of these barriers, we have previously shown that the absence of STI testing at the service created a barrier to returning, some clients reporting returning to testing for HIV at other services after their first test at PRONTO!. 31 The lack of STI testing at PRONTO! likely contributed to the difference in the proportion of GBM returning for a HIV test at PRONTO!…”

“…alongside intermittent HIV testing elsewhere. 31 Intermittent testing at PRONTO! may relate to a variety of factors.…”

Assessment of service refinement and its impact on repeat HIV testing by client's access to Australia's universal healthcare system: a retrospective cohort study

“…found that while features of the HIV testing service model (e.g. community‐based, peer‐led, RPOC test) were highly acceptable , the lack of sexually transmissible infection (STI) testing introduced a significant barrier to returning to the service for HIV testing .…”