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Rapid HIV and Sexually Transmissible Infections Testing

South Eastern Sydney Local Health District
Project Added:
16 February 2015
Last updated:
16 February 2015

Rapid HIV and Sexually Transmissible Infections (STI) Testing

Summary

Sydney Sexual Health Centre with partners ACON and the Kirby Institute, developed outreach testing models staffed by peer educators and a specialist nurse. a[TEST] models included after-hours testing at community organisation premises, a mobile testing caravan at Taylor Square for World AIDS Day, and a Darlinghurst shop front for the Mardi Gras Festival 2014. High rates of consumer satisfaction with the models and success in accessing gay men who had never had a HIV test or were testing infrequently was demonstrated. This partnership successfully implemented the first peer-led community-based rapid HIV testing service in Australia.

atest logo

This project was the recipient of the Local Solutions Award at the 2014 NSW Health Awards. Download a poster from the 2014 NSW Health Awards.

Aim

To develop and implement innovative HIV testing models to meet the NSW (HIV Strategy 2012-2015) targets for increased testing in high-risk populations.

Benefits 

  • Improved access to timely care for high risk populations
  • Reduced risk of HIV transmission, complications and hospitalisations
  • Quicker and more cost efficient patient journey
  • Improved time efficiency and increased number of tests carried out
  • Improved collaboration and partnerships with community, non-profit and research
  • Improved integrated care and support to care for patients 
  • a[TEST] empowers consumers to take control of their sexual health and test more frequently for HIV in a way that suits them best
  • It empowers peer educators in a new clinical role.

Project status 

Sustained: The project has been implemented and is sustained in standard business.

Background

This project was an initiative to address a local need.  Increasing the frequency of HIV and STI testing among high risk populations is a central component of HIV/STI control strategies. 

Many of the testing barriers in the literature relate to traditional testing models where individuals are required to make an appointment, complete an extensive risk assessment and then attend a separate clinic visit for results. The sector works to achieve the Australian Government target of ending HIV by 2020.

Implementation 

  • The model was the first to pilot non-medically trained community peer educators facilitating access to high risk people while working alongside a nurse, to provide rapid HIV and STI testing.
  • The peer educators completed a nationally accredited training program on the use of the HIV rapid test and also completed a specifically designed clinical placement and competency assessment in the provision of HIV and STI testing. 
  • The model used rapid HIV testing so that patients could receive their test results in 10 minutes. This testing was only available in Australia via a research trial being conducted by the Kirby Institute. 
  • Computer assisted self-interview kiosks were used to collect relevant information and reduce barriers to access. This technology is mobile and adaptable to different settings and was developed specifically for use outside of traditional health services.
  • Process, cost benefit, acceptability and effectiveness evaluation was built into the various a[TEST] models in partnership with the Kirby Institute.
  • The total patient journey in the new model ranges from 20 to 30 minutes including receiving results. Providing same visit HIV results prevents the need and cost of a second appointment and enables services to screen more people. 

Partnerships

Sydney Sexual Health Centre, ACON and The Kirby Institute for infection and immunity in society.

The partnership has been a synergistic relationship that has allowed the individual organisations to share their strengths and skills with the other partners.

Implementation sites 

The HIV and STI testing models used in this collaboration have been taken up by two other sexual health clinics in Sydney and one rural testing location. Given the success of the testing models in detecting new HIV cases and reaching men who are untested or tested less frequently for HIV, the NSW Ministry of Health has undertaken to have the models rolled out across the state. 

Results

  • A comparison between the a[TEST] model and a clinic based fast track service showed the service attracted high risk gay men and it tested significantly more men per hour.
  • More than 2000 high risk men have attended these services and of these 20% have never had a HIV test previously - suggesting this service model has attracted a proportion of men who would not access traditional services.   
  • A total of 18 new HIV diagnoses (prevalence of 2.3%, more than double the prevalence seen in comparable fixed site services) have been made and all men have been linked to clinical care and support. 
  • Approximately 14% of men have had an STI diagnosed and all have been treated. This model of service delivery has reduced the burden of asymptomatic HIV and STI infection in the community - reducing the risk of onward transmission, the risk of complications and hospitalisations from undiagnosed infections.
  • Patients attending the testing services were asked to complete a satisfaction and acceptability survey. A total of 374 testers (64%) completed the survey in the pilot. Over 99% of patients agreed or strongly agreed they were satisfied with the overall service. 
  • Being able to get results at the same visit was the main reason why patients selected the testing services. Location and being in a community organisation were also rated very highly as was being a free service.
  • Expressions of interest have been received from another 6 services. In a cost analysis yet to be published by The Kirby Institute, the cost of rapid HIV testing via the a[TEST] outreach model was shown to be comparable to rapid testing conducted in public sexual health clinics, which is significant given that outreach testing models are often more expensive than dedicated fixed site services.
  • Various models of a[TEST] that were responsive to the particular setting were used. Evaluation of the models found a high proportion of untested gay men attended the services and that all those who had a positive HIV or STI test were linked to care. This demonstrates that a[TEST] was meeting an unmet need in the community, also supported by high levels of client satisfaction. a[TEST] models are now being rolled out across the state in a variety of settings.

Lessons Learnt

Innovative, evidence based testing models such as these that are collaborations between health services, community organisations and research facilities can be used by any health organisation wanting to engage their community and increase access to testing for their target population. 

Contact

Ms Anna McNulty
Director, Sydney Sexual Health Centre
South Eastern Sydney Local Health District (SESLHD)
Phone: 02 9382 7476
Email: Anna.McNulty@sesiahs.health.nsw.gov.au

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