New research from the Kirby Institute at UNSW Australia indicates that gay and bisexual men prefer point-of-care HIV testing to conventional laboratory testing and are likely to test more frequently for HIV if point-of-care testing is available to them.
In the largest clinical evaluation of HIV point-of-care testing reported to-date in Australia, a team of researchers led by the Kirby Institute assessed the performance and acceptability of the Alere Determine HIV-1/2 Ag/Ab Combo rapid test when used in a sexual health clinic setting, compared to standard of care conventional laboratory HIV blood testing.Results from the study published in the journals PLOS One and HIV Medicine suggest that despite some limitations in the tests’ ability to detect recently acquired HIV, this testing method is highly acceptable to both clinic staff and patients.
“Two thirds of gay and bisexual men surveyed said they would test more often for HIV if point-of-care testing was available to them and four out of five men would prefer to have point-of-care testing rather than conventional laboratory testing the next time they test for HIV”, said Dr Damian Conway, primary investigator of the study.
Though the rapid test detected established cases of HIV infection well, it was less sensitive when patients were in the early stages of HIV infection, detecting 34 out of a total 39 (87.2%) cases of HIV. “The patients in our study were made aware of the limitations of the rapid test, yet we still found that it was preferred by men, with almost every participant being satisfied with how it was delivered,” said Dr Conway. “Point–of-care HIV testing was also highly acceptable to the clinic staff at baseline, and we found that staff acceptability scores improved over time.”
The Determine HIV Combo was the first rapid test approved for point-of-care use by regulatory authorities in Australia in 2012. Since then, both NSW and National HIV strategies have recommended the introduction of point-of-care HIV testing, community based testing and quicker provision of test results to make testing easier and more convenient. Two other point-of-care HIV tests have been submitted for licences in Australia by their manufacturers, but the outcomes of their applications are not yet publicly known.
Investigators at four public sexual health clinics, the State Reference Laboratory for HIV and the Centre for Social Research and the Kirby Institute at UNSW collaborated on the Sydney Rapid HIV Test Study between October 2011 and July 2013. Trained clinicians offered point-of-care testing with Determine HIV Combo to men presenting for HIV testing who were 18 years or older and who reported having sex with other men. All of the 3195 patients who were tested using the rapid test were also tested using the conventional laboratory-based method so that the results could be compared. The acceptability of point-of-care testing was assessed via questionnaires completed by patients during their consultation while clinic staff were surveyed after their training and again at least six months later.
“The results of the study demonstrate both the benefits and the limitations of point-of-care HIV testing,” said Dr Conway. “While it has demonstrated high acceptability among both clinic staff and patients, the risks and benefits of point-of-care HIV testing should be weighed up carefully when decisions are made about testing. If point-of-care HIV testing is more acceptable to patients, especially those who have never tested before or test infrequently, it may result in patients testing more frequently for HIV infection and more cases of HIV being detected.”
Since the study ended, both clinics and community-based sites in NSW have implemented point-of-care HIV testing (with parallel conventional laboratory testing so that no cases of recently acquired infection are missed). Community sites like ACON’s a[TEST] services have been very successful in reaching many men who have not tested before. The NSW Ministry of Health and ACON are currently promoting more frequent HIV testing and raising community awareness of the need for earlier HIV diagnosis during the HIV Testing Week and Ending HIV campaigns.
“This study adds to the evidence that rapid HIV tests can decrease barriers to testing by reducing the amount of anxiety that can arise from waiting for a result,” said Nicolas Parkhill, CEO of ACON, the leading health promotion organisation specialising in HIV prevention in NSW. “As we encourage gay men to test more often, it is incumbent on us to also make testing easier to access and undertake. We have also seen through our community-based a [TEST] services that many gay men have a preference for rapid HIV testing and we hope that this research will help spur more services to offer this type of testing. Increasing HIV testing is a critical component of ending the HIV epidemic in Australia.”
The study was supported by funding from the National Health & Medical Research Council, the NSW Ministry of Health, Australian Rotary Health and Sydney CBD Rotary Club.
The Kirby Institute, UNSW Australia
(02) 9385 0550
Conway DP, Guy R, Davies SC, Couldwell DL, McNulty A, Smith DE, Cunningham P, Keen P, Holt M. Rapid HIV Testing Is Highly Acceptable and Preferred among High-Risk Gay And Bisexual Men after Implementation in Sydney Sexual Health Clinics. PLOS One. 2015, 10(4):e0123814.
Conway DP, Guy R, McNulty A, Couldwell DL, Davies SC, Smith DE, Keen P, Cunningham P, Holt M. Effect of testing experience and profession on provider acceptability of rapid HIV testing after implementation in public sexual health clinics in Sydney. HIV Medicine. 2015, 16: 280–287.
Conway DP, Holt M, McNulty A, Couldwell DL, Smith DE, Davies SC, Cunningham P, Keen P, Guy R. Multi-centre evaluation of the Determine HIV Combo assay when used for point of care testing in a high risk clinic-based population. PLOS One. 2014, 9(4): e94062.
NSW Ministry of Health. NSW HIV Strategy 2012-2015: A New Era.
NSW Ministry of Health. HIV Testing Week 2015.
Australian Government Department of Health. Seventh National HIV Strategy 2014–2017.