Access to HIV home tests doubles the frequency of HIV testing in Australian gay men

Access to HIV home tests doubles the frequency of HIV testing in Australian gay men

Muhammad Jamil presenting at AIDS 2016. Photo by Roger Pebody, www.aidsmap.com

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.

Glossary

self-testing

In HIV testing, when the person testing collects their own sample and performs the whole test themselves, including reading and interpreting the result. 

control group

A group of participants in a trial who receive standard treatment, or no treatment at all, rather than the experimental treatment which is being tested. Also known as a control arm.

condomless

Having sex without condoms, which used to be called ‘unprotected’ or ‘unsafe’ sex. However, it is now recognised that PrEP and U=U are effective HIV prevention tools, without condoms being required. Nonethless, PrEP and U=U do not protect against other STIs. 

linkage to care

Refers to an individual’s entry into specialist HIV care after being diagnosed with HIV. 

sample

Studies aim to give information that will be applicable to a large group of people (e.g. adults with diagnosed HIV in the UK). Because it is impractical to conduct a study with such a large group, only a sub-group (a sample) takes part in a study. This isn’t a problem as long as the characteristics of the sample are similar to those of the wider group (e.g. in terms of age, gender, CD4 count and years since diagnosis).

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 year.

A total of 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 self-tests.
  • 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 self-tests.
  • 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.

References

Jamil MS et al. Access to HIV self-testing doubles the frequency of HIV testing among gay and bisexual men at higher risk of infection: a randomised controlled trial. 21st International AIDS Conference, Durban, abstract FRAC0102, 2016.

View the abstract on the conference website.

Watch the webcast of this presentation on YouTube.