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Access to HIV home tests doubles the frequency of HIV testing in Australian gay men
Roger Pebody, 2016-07-24 16:50:00
A randomised trial conducted with Australian gay men has
shown that easy access to self-testing kits can double the frequency with which
men test for HIV, with an even greater increase in men who used to test
infrequently. Muhammad Jamil of the Kirby Institute presented the results to
the 21st International AIDS Conference (AIDS 2016) in Durban, South
Africa, on Friday.
Australian guidelines recommend that sexually active gay men
should test for HIV at least once a year and that men at higher risk of HIV
should test every three to six months. However a third of men at higher risk
only test once a year or not at all.
HIV self-tests (devices for home testing) have been approved
for sale in the United States, United Kingdom, France and other countries.
Australian policy changed in 2014 to allow manufacturers to submit self-tests
for regulatory approval, but none have done so yet.
The Frequency of Oral Rapid Testing at Home (FORTH) study
recruited gay and bisexual men who were at higher risk of HIV – in the previous
three months, they had either had condomless anal intercourse at least once or had
had five or more sexual partners.
In this randomised study, half the men received four
self-testing kits (the OraQuick In-Home HIV Test) and could request additional
kits if needed. The number of kits provided corresponds to the recommendation
that higher risk men test every three to six months.
Men in the control group only had access to HIV testing
through usual services, but would be provided with self-testing kits after one
362 men were recruited through sexual health clinics, AIDS
service organisations and social media in Sydney and Melbourne. Their average
age was 35, two thirds were in full-time employment and a third were university
educated. In the previous six months, half had had more than ten sexual
partners in the previous six months and six-in-ten had had condomless anal sex
with a casual partner.
For analysis, men were divided into ‘recent testers’ who had
taken an HIV test in the two years before the study began and ‘non-recent
testers’ who had not. Most men were in the first group.
The primary outcome measured was the average (mean) number
of HIV tests per man during the first year of follow-up.
Looking first at recent testers:
- Men in the intervention group took an average of 1.8 tests
at health facilities, while men in the control group took 2.1 tests.
- Men in the intervention group also used an average of 2.4
- Men in the intervention group therefore took a total of 4.2
tests in the year, compared with 2.1 in the control group – a doubling of the
rate (risk ratio 2.0, p<00.1).
Results were even more impressive among men who had
previously tested infrequently.
- Men in the intervention group took an average of 0.8 tests
at health facilities, while men in the control group took 0.7 tests.
- Men in the intervention group also used an average of 2.1
- Men in the intervention group therefore took a total of 2.9
tests in the year, compared with 0.7 in the control group – a four-fold
increase (risk ratio 3.95, p<00.1).
The equal number of tests done in health facilities between
intervention and control arms shows that self-tests supplemented rather than
replaced facility-based testing.
The researchers were concerned that the easy access to HIV
self-tests could result in fewer men in the intervention group going to a
clinic to test for sexually transmitted infections. But there were no
differences in the number of sexual health screens done (two per year in
‘recent testers’ and one per year in ‘non-recent testers’).
The researchers asked what men receiving self-tests liked
about them. They mentioned being able to test themselves (92% of men), convenience
(83%), not needing to go to a doctor or clinic (75%), getting the result within
minutes (74%), being able to test when you want (74%), saving time
(66%), privacy (62%), not requiring a blood sample (51%) being able to test
partners (41%) and being less embarrassing (26%).
The only negative points about HIV self-testing to be agreed
with by a comparable number of people were it not being possible to have a full
sexual health check (57%) and the results being less accurate (25%).
The findings strengthen the evidence that access to free
HIV self-testing increases testing frequency in high-risk gay and bisexual men,
concluded Muhammad Jamil.
In the UK, a large trial called SELPHI is about to recruit
10,000 men who have sex with men. It aims to assess whether access to
self-testing for HIV (offered at no cost via the internet) leads to increased
rates of HIV diagnosis and linkage to care.