ASHM Report Back

Clinical posts from members and guests of the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) from various international medical and scientific conferences on HIV, AIDS, viral hepatitis, and sexual health.

Findings from the national online HIV self-sampling service in England. (Luis Guerra).

I found this talk to be if interest because in NSW we have launched the Dried Blood Spot - Home HIV self testing.

In England - eligible participants go to a website - WWW.freetesting.hiv and answer a. Few questions and then get a box sent the address they register.

The person then follows the instructions in the kit and utilising a lancet leaves a blood spot which is then posted back for testing.

Results are then sent out within 3 days via the delivery method the participant chooses.

If the result shows Reactive - the participant is contacted via phone and notified of the Reactive result - explaining the possible outcomes of a reactive result (Explaining it doesn't mean its a positive test).

The participant is given the details of local clinics and services and offered an appointment or they are able to book themselves.

Of the 40726 kits sent out - 22085 were returned. That's a 54% return rate.

There were 239 reactive samples.

Of those that tested 30% had never had a test. And 32% last tested over 1 year ago.

 

I hope that the NSW Dried blood spot testing program has such a high return rate and that we are able to capture the amount of people that otherwise would not have tested.

 

 

This morning I attended the Oral presentations for HIV/STI testing and management, looking at different studies around HIV risk.

Brendan Harney from Melbourne presented his study: Risk of HIV following repeat sexually transmissible infections among men who have sex with men in Victoria, Australia. 

This presentation was a retrospective study questioning, if MSM have repeat positive STI diagnoses, are they at an increased risk of HIV transmission? 

Out of 8941 MSM (median age 29, Australian born) surveyed at a busy Melbourne Sexual Health Centres, 2.5% were diagnosed as HIV positive.

Although repeat Chlamydia and Syphilis notifications were common, Rectal gonorrhoea was found to be the highest, with 13.5% of those with a repeat positive gonorrhoea rectal infection becoming HIV positive.

Conclusion? Repeat Gonorrhoea infections are strongly associated with a HIV infection, and that this data is key to looking at PrEP inclusion criteria and why we target specific groups and behavioural activities for PrEP enrolment studies. 

 

Point of care testing - is it the way of the future? Dr Tarim Sadiq (St. George's University of London) Spoke about new POC testing technologies currently used and some that are in the pipeline of development. 

Dean street Clinic in London are currently utilising the GenXpert POC tests where results are available in 90 minutes. However most clients do not want to wait in the clinic for 90 minutes. Available now and with more in the pipeline are a new generation of POC tests where results will be available in under 30 minutes. Meaning that clients can receive treatment at the initial consult if they have a positive test result. 

In the not to distant future POC tests that can test for CT. NG. MG and TV will be available. And resistance testing for NG and Macrolide resistance in MG will be available in the POC Tests also. 

So what are the barriers to implementation of POC tests. And is there a space for their use in Australia. 

Firstly the COST - In Australia in the sexual health clinic setting we have access to tertiary hospital laboratories. Do we need to outlay more money for POC tests to be available  in the clinic setting?

And what are the public perspectives in relation to POC testing - are they open to the idea of using POC tests or do they want conventional laboratory tests thinking they are more accurate?

The talk at the conference is that POC tests are the way of the future, How we integrate them into our practice is another question.

The exciting thing that I believe comes from POC testing is that resistance testing for STIs will be available quickly meaning the right medication can be used first go. 

Thoughts? 

 

New approaches to HIV testing

Delayed HIV testing among men who have sex with men in Australia has improved but remains an issue – Huachun Zou

KEY POINTS

 

·      Delayed testing (testing less than annually) in MSM has improved but there is still some way to go

·      In Australia it is predicted that there are approximately 12-33% of people living with HIV who are undiagnosed

·      2/3 MSM consistently report testing but less than 40% return to be retested within 1yr

·      If all MSM were tested as recommended (every 3-6 months), modelling predicts there would be a 14% decrease in new HIV diagnosis

·      However, surveys have shown that only 1/3 are ‘very likely’ to increase testing levels. Many MSM don’t test annually and those at higher risk (5 partners in 3/12, >20 partners in 12/12, having had an STI in 2y) tend to be the most unwilling to increase testing.

·      ACCESS data from 2007-2014 from 24 sexual health clinics showed those more likely to test >p.a were under 25. Only 36% of high risk MSM tested annually and only 2% ATSI.

·      Amongst those at high risk delayed testing has improved from 75% to 69%, with delay in testing being more likely if ATSI, this was statistically significant.

·      In conclusion delayed testing is still common in high risk MSM especially if older or ATSI

Normal 0 false false false EN-GB JA X-NONE

·      Strategies to improve testing further could include ?home based/ self test HIV testing, 3/12,  sms reminders (shown to work), computer alerts in GP practices and guidelines on testing (also shown to work).

Day 4- Increasing the demand for HIV testing

Mark Stoove discussed innovative ways to improve HIV testing.  50-70% of HIV transmission among GBM are attributed to undiagnosed infection. There were policy and regulatory changes in 2012, which revolutionised HIV testing in Australia. Rapid HIV testing was introduced and there was an increase in HIV testing in community settings. The uptake of rapid HIV testing has been modest. Barriers may include funding, lack of government subsidy and some services feel testing can be time and resources heavy. The majority of HIV testing continues to occur in primary health care settings using serological laboratory testing

Community based HIV testing services such as ACON provide a comfortable, peer based service which clients find very acceptable.  ACON in Sydney provides a peer based testing model, which is supported by nursing staff. Peer based clinics have successfully attracted first time testers that were classified as ‘high risk’. Rapid HIV testing has increased testing in urban areas but more needs to be done for those living in rural areas. We need to expand the geographical reach of HIV testing. The Terence Higgins Trust provided funding to increase testing in the UK. In a 14-month pilot study over 17,500 testing kits were posted and 10,410 specimens were returned. There was a positivity rate of 1.4% and this testing was welcomed by participants with 97% reporting that they would test this way again. Self-testing kits are available in the UK and the uptake has been excellent with over 27,000 units sold between April 2015 –Feb 2016. Half of the test kit users have never had a HIV test before.

Key messages

-We need to ramp up HIV testing

-Self testing kits should be available in available

-Funding may be a barrier for services offering HIV testing. Government subsidies could improve rates of HIV testing

 Vickie Knight spoke about the effect a[TEST] clinics has had on HIV testing among gay and bisexual men. It was found that the clinic on Oxford Street in Sydney has increase testing and also increased the frequency of testing. Factors that make this clinic user friendly include short wait times, the service is free, CASI is used which means intrusive sexual health histories are not taken by health professionals.

 

Key messgaes

This model works and has increased testing among GBM.