Effect of testing experience and profession on provider acceptability of rapid HIV testing after implementation in public sexual health clinics in Sydney

Abstract

ObjectivesRapid HIV testing (RHT) is well established in many countries, but it is new in Australia since a policy change in 2011. We assessed service provider acceptability of RHT before and after its implementation in four Sydney public sexual health clinics. MethodsService providers were surveyed immediately after training in RHT and again 6-12 months later. Differences in mean scores between survey rounds were assessed via t-tests, with stratification by profession and the number of tests performed. ResultsRHT was rated as highly acceptable among staff at baseline and acceptability scores improved between survey rounds. Belief in being sufficiently skilled and experienced to perform RHT (P = 0.004) and confidence in the delivery of nonreactive results increased (P = 0.007), while the belief that RHT was disruptive declined (P = 0.001). Acceptability was higher for staff who had performed a greater number of tests regarding comfort with their role in RHT (P = 0.004) and belief that patients were satisfied with RHT (P = 0.007). Compared with nurses, doctors had a stronger preference for a faster rapid test (P = 0.027) and were more likely to agree that RHT interfered with consultations (P = 0.014). ConclusionsDifferences in responses between professions may reflect differences in staff roles, the type of patients seen by staff and the model of testing used, all of which may affect the number of tests performed by staff. These findings may inform planning for how best to implement RHT in clinical services.Keywords: provider acceptability, rapid HIV testing, sexual health clinics, staff attitudes [6,7]. However, if rapid HIV testing (RHT) and other novel approaches to testing are adopted, this may reduce barriers to and increase acceptability of HIV testing, and may facilitate more frequent testing for high-risk populations [8,9]. In Australia, HIV testing has traditionally involved venipuncture specimen collection at a clinic with results provided 1 week later in person or by telephone [10]. Finding time to test, inconvenience and having to return for results are recognized barriers to more frequent HIV testing among MSM [10,11]. In contrast, RHT involves finger-prick blood or oral fluid specimen collection with results provided during the same visit, which may make testing more convenient. Barriers to implementing RHT reported among service providers include: lack of time [12,13]; lack of confidence in their own competency and skills and fear of delivering positive results [14,15]; concern regarding reliability and false positive results [16,17]; and perceiving RHT as too difficult for nonexperts [18].Although many studies have assessed acceptability of RHT in a variety of settings and patient groups, and among providers at various stages of implementation [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28], few studies have assessed differences in acceptability between professions [29,30]. To our knowledge, no published studies have examined if the number of tests performed and experience o...

The contribution of HIV point-of-care tests in early HIV diagnosis: community-based HIV testing monitoring in Catalonia, 1995 to 2018

“…The POCT that meet the WHO’s ASSURED (affordability, sensitivity, specificity, user-friendly, rapid and robust, equipment-free and deliverable) criteria [ 25 ] follow a simple procedure involving a limited number of steps and are equipment-free, ensuring they can be performed outside traditional laboratory settings by staff with no formal laboratory training [ 24 ]. Additionally, both providers and clients prefer rapid tests over traditional tests [ 26 , 27 ]. Several studies have shown the efficacy of CBVCT strategies using HIV POCT to improve HIV testing uptake in populations at higher risk of exposure to HIV [ 6 , 7 , 9 ].…”

Rapid HIV Testing Is Highly Acceptable and Preferred among High-Risk Gay And Bisexual Men after Implementation in Sydney Sexual Health Clinics

“…Our study involved written consent, completion of a survey and it used a 20-minute incubation rapid test with the patient receiving their result during their clinic visit. Previous studies have shown patients prefer quick delivery of HIV results within an hour [ 22 , 24 ]; hence, tests with shorter incubation times of 10 minutes or less may be important to consider in future RHT programs and may allow easier integration of RHT into screening consultations [ 31 ]. Though other studies have also reported patient concern about the reliability of RHT and that patient preference for RHT was conditional on its performance being similar to that of CHT [ 28 , 40 ], these studies did not assess how that influenced the preference for RHT next time via multivariate analysis.…”

“…Rapid test performance was compared with the standard of care laboratory serology assays used in this setting and barriers to testing and patient and staff acceptability were assessed via surveys. The performance and provider acceptability data and methodology have previously been published [ 30 , 31 ]. Among GBM surveyed in New South Wales in 2013, 45% of men who had ever tested for HIV reported that their most recent test was at a public sexual health clinic [ 32 ].…”

Increasing HIV testing among hard-to-reach groups: examination of RAPID, a community-based testing service in Queensland, Australia

“…In response, researchers and service providers have introduced and evaluated innovative approaches and strategies designed to facilitate access to testing. These include the adoption of rapid HIV testing (RHT) technology, use of community and outreach settings for testing, use of peer services, and establishing testing services that do not require the disclosure of sexual history [8, 10, 14]. The following paper reports on the implementation of ‘RAPID’, a novel RHT program developed in Queensland, Australia that has employed a mix of the above-mentioned strategies to increase access to HIV testing.…”

“…Studies comparing RHT with standard testing have found most participants prefer RHT, identifying it as more comfortable, convenient and less stressful [14, 21–23]. Table one provides a summary of the comparisons between community-based RHT services, such as RAPID and clinical services offering conventional HIV testing.…”