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.

Day 1: SARAH Bell - Research Officer, University of Queensland

 It is interesting to know of such a project in Queensland:  HIV Self Testing (HIVST) service.

 The aim of the service is to pilot and evaluate the efficacy of the program, determining if it increases access to HIVST particularly for gay and other men who have sex with men (MSM), infrequent and new testers and those in regional and remote areas. A model was formulated which includes recruitment pathways through dating apps, word of mouth, gay apps and social media sites; all designed to engage those mentioned population. Ordering of the HIVST kit along with a completed survey were all done on-line. They receive and return the kit. Once test was done, they receive a follow-up phone call giving contacts to organizational support if test was reactive and an option for test reminders if non-reactive.

 As of 30 September 2017, 630 kits were ordered of which 516 are from Queensland and the rest are from different states. Main reason stated for availing of the service was unprotected sex and test access convenience.

These are the preliminary results from the targeted population:

  • 71.9% reside in Major QLD city compared to only 1.4% from remote or very remote QLD.
  • 65% of gay and other MSM used the service.
  • 38.3% are those that have never had any form of HIV testing
  • 23.9% those who have had HIV tests done >12 months

In the light of these findings, it can be said that the service will be a success if rolled out state-wide or nationally mainly because of its dicreteness and test accessibility. However more should be done to somehow tap those in remote places and to also target Aboriginal and TSI populaion. These findings will inform further improvements to better the service and provide more access to marginalized population.  

 

 

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

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·      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).

Please join us for a memorial event celebrating the life of one of Australia’s leading HIV advocates, Levinia Crook… https://t.co/N7dof5xaGa

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