HIV dried spot test: Internet based self sampling increases access to HIV testing

Anna McNulty presented about the New South Wales initiative of posted self collected HIV dried blood spot testing. This is of interest to me as I work in a sexual health clinic in a regional setting and I'm aware of how isolated some people are who could benefit from a HIV test.  In my setting I'm aware of isolated MSM who are not out in the local community and/or don't want to be seen at a sexual health clinic or are unable to travel to a local sexual health clinic. Some feel unable to discuss this with their GP or may not even have access to a GP.

 Background to this project:

• HIV New South Wales strategy identifies GBM and CALD  as priority populations for testing
• 11% of people with HIV in New South Wales are undiagnosed
• GBN are interested in self testing however currently not available
• Those from CALD communities are more likely to be diagnosed late 

 How it works: 

•  Dried blood spot test (DBS) test ordered via website
•  Person uses small lancet to prick finger and apply blood to small circles on blotting paper, 5 drops preferred
•  Sample is returned in the reply paid envelope to SVH lab
•  Negative results SMS via Sexual Health Infolink (SHIL)
•  Positive results via phone 

 Promotion: 

•  Promoted through social media and local initiatives
• Translated into 10 languages 

Results:

• November 2016 to end of September 2017 there were 505 registrations
• 77% MSM, 32% had partners from Asia or Africa, 26%  were from Asia or Africa, 14% CALD MSM, 11% CALD heterosexual, 4%had ever injected drugs or  5% Aboriginal. Note people could be for more than one group
• 58% kit return rate
• 54% have never tested or tested greater than two years ago
• Median kit return time was 18 days
• Reactive results: 1 confirmed and the person linked to care, another recent reactive result
• There were 39 repeat testers

Feedback from users of the test  in a post test survey:

• Test participants  were very supportive of HIV testing done this way and we're very happy they had the opportunity to test.  Feedback included: They  could test  in private, the test was was quick, free, convenient, no need to go to GP,  allows me to test ahead, it is less embarrassing, easy to do

Conclusions: 

•  Successful implementation however slowper uptake than anticipated
• Difficult to reach heterosexual CALD
•  Expected 1% HIV positivity
• Marketing is the key to uptake

Future:

• Phase 2 site specific projects including addition of hepatitis C RNA testing and Aboriginal and PWID added as populations to be targeted
• SOPV
• NSPs
• D&A services