Increased targeted HIV testing and reduced undiagnosed HIV infections among gay and bisexual men

Patel, PG; Keen, Phillip; McManus, Hamish; Duck, Tim; Callander, Denton; Selvey, Christine; Power, Cherie; Gray, Rebecca; Knight, Vickie; Asselin, Jason; Read, Phillip; Johnson, Karl; Bavinton, BR; Bowden, VJ; Grulich, AE; Guy, Rebecca; Grulich, Andrew E.; Prestage, Garrett; Zablotska, Iryna; Holden, Jo; Holt, Martin; Wit, John de; Kaldor, John; Kelleher, Anthony D.; Wilson, David; Brotherton, Alan; Cooper, David A.; Crooks, Levinia; Whittaker, Bill; Madeddu, Daniel; Schmidt, Heather-Marie A; Telfer, Barbara; Price, Karen; Boyd, Mark; Cooper, Craig; McGill, Scott; Pinto, Angie N; Nigro, Steven J.; Gordon, Tina; Feeney, Lance; Cunningham, Philip; Mao, Limin; Gray, James; O’Dwyer, Matthew; Clifton, Brent

doi:10.1111/hiv.13102

Cited by 9 publications

(14 citation statements)

References 25 publications

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“…3 However, the frequency of HIV testing among men who have sex with men is inadequate, particularly among those who are not receiving PrEP 4,5 or were born overseas. 6 Consequently, late HIV diagnoses remain relatively common; during 2008-2017, 23% of Australian-born and 37% of East Asia-born men diagnosed with HIV had CD4+ counts below 350 cells/μL. 7 Barriers to HIV testing include low perceived risk of infection, the stress of waiting for results, and fear of a positive result.…”

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confidence: 99%

“…3 Kirby Institute, University of New South Wales, Sydney, NSW.4 Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland. 5 Sydney Sexual Health Centre, Sydney, NSW 6. The University of New South Wales, Sydney, NSW 7.…”

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confidence: 99%

“…HIV testing is a key prevention strategy, 2 and the gateway to both treatment for those with positive test results and to pre‐exposure prophylaxis (PrEP) for people with negative results 3 . However, the frequency of HIV testing among men who have sex with men is inadequate, particularly among those who are not receiving PrEP 4,5 or were born overseas 6 . Consequently, late HIV diagnoses remain relatively common; during 2008–2017, 23% of Australian‐born and 37% of East Asia‐born men diagnosed with HIV had CD4+ counts below 350 cells/μL 7…”

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confidence: 99%

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The acceptability and usability of two HIV self‐test kits among men who have sex with men: a randomised crossover trial

Lee

Ong

Smith

et al. 2022

Medical Journal of Australia

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Objectives To compare the usability and acceptability of oral fluid‐ and blood‐based HIV self‐test kits among men who have sex with men in Australia. Design Randomised crossover trial. Setting, participants Gay, bisexual, and other men aged 18 years or older who have sex with men, who attended two metropolitan sexual health clinics in Sydney and Melbourne, 7 January – 10 December 2019. Main outcome measures Ease of use of HIV self‐test kits; preferred HIV self‐test type; difficulties encountered during HIV self‐testing. Results 170 men were recruited (median age, 34 years; interquartile range, 29–43 years); 144 identified as gay (85%), 96 were born outside Australia (57%). Participants were more likely to report the oral fluid HIV self‐test was easy to use than the blood‐based self‐test (oral fluid, 99%; blood, 86%; odds ratio [OR], 3.0; 95% confidence interval [CI], 1.4–6.6). The oral fluid test was preferred by 98 participants (58%; 95% CI, 50–65%), the blood‐based test by 69 (41%; 95% CI, 33–48%). Difficulties with the oral fluid test kit identified by observing nurses included problems placing the buffer solution into the stand (40 of 170 participants, 24%) and not swabbing both gums (23 of 169, 14%); difficulties with the blood‐based test kit included problems filling the device test channel (69 of 170, 41%) and squeezing the finger firmly enough to generate a blood drop (42 of 170, 25%). No participant received an invalid result with the oral fluid self‐test; two of 162 participants (1%) received invalid results with the blood self‐test. After adjusting for age, education level, and ethnic background, characteristics associated with higher odds of using HIV self‐testing in the future were overseas birth (adjusted OR, 3.07; 95% CI, 1.42–6.64), and self‐evaluated ease of use and confidence in using the kits. Conclusion It is important to provide options for obtaining both oral fluid‐ and blood‐based HIV self‐tests. The usability and acceptability of both kits were high, but the ease of use and perceived accuracy influenced test kit preference.

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The acceptability and usability of two HIV self‐test kits among men who have sex with men: a randomised crossover trial

Lee

Ong

Smith

et al. 2022

Medical Journal of Australia

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“…Moreover, migrant GBMSM may face additional cultural and healthcare system barriers such as unfamiliarity with the local health system, distrust of health providers, and privacy concern, further hindering their access to HIV testing in conventional settings ( 11 – 13 ). Between 2014 and 2019, HIV diagnoses among Australian-born GBMSM declined by 44%, which likely occurred due to improved coverage of HIV testing and treatment, and implementation of PrEP across Australia ( 14 ). However, this success was offset by increased diagnoses among people born in other countries resulting in a relatively stable number of annual diagnoses overall ( 15 ).…”

Section: Introductionmentioning

confidence: 99%

“…However, this success was offset by increased diagnoses among people born in other countries resulting in a relatively stable number of annual diagnoses overall ( 15 ). Surveillance data from 2018 suggest that migrant GBMSM in Australia are three times more likely to be undiagnosed for HIV and three times more likely to be diagnosed late than Australian-born GBMSM ( 14 ). Delays in testing lead to delayed treatment ( 16 ), and untreated HIV infections can disproportionately contribute to HIV transmissions ( 17 – 19 ).…”

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Preferences for HIV Testing Services and HIV Self-Testing Distribution Among Migrant Gay, Bisexual, and Other Men Who Have Sex With Men in Australia

et al. 2022

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BackgroundIn Australia, undiagnosed HIV rates are much higher among migrant gay, bisexual, or other men who have sex with men (GBMSM) than Australian-born GBMSM. HIV self-testing is a promising tool to overcome barriers to HIV testing and improve HIV testing uptake among migrant GBMSM. We compared the preferences for HIV testing services, including HIV self-testing, among migrant and Australian-born GBMSM.MethodsPreferences were assessed via two discrete choice experiments (DCEs). Participants were recruited between December 2017 and January 2018 using online and offline advertising and randomly assigned to complete one of two online DCE surveys. Migrant GBMSM were classified as being born in a country with a reciprocal healthcare agreement (RHCA) with Australia (providing free or subsided health care) or not. Latent class analysis and mixed logit models were used to explore heterogeneity in preferences.FindingsWe recruited 1,606 GBMSM, including 583 migrant men of whom 419 (72%) were born in non-RHCA countries. Most participants preferred a free or cheap oral test with higher accuracy and a shorter window period to facilitate early detection of infections. Cost was more important for men born in non-RHCA countries than for men from RHCA countries or Australia. All groups preferred accessing kits through online distributers or off the shelf purchasing from pharmacies. Men born in RHCA countries least preferred accessing HIV self-testing kits from a medical clinic, while more than half of men from non-RHCA countries most preferred sourcing kits from a clinic. Sex-on-premises venues were the least preferred location to access test kits among all groups. In addition, two latent class analyses explored heterogeneity in preferences among men from non-RHCA countries and we found four latent classes for HIV testing services and two latent classes for HIVST distribution.InterpretationOur findings emphasise the need for high-performing and low-cost HIV self-testing kits that are accessible from a variety of distribution points as a component of Australia's HIV response, especially for those who do not have access to free or subsidised health care in Australia.

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National Surveillance of Home-Based HIV Testing Among Australian Gay and Bisexual Men, 2018–2020: Uptake After Commercial Availability of HIV Self-Tests

et al. 2023

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HIV self-testing allows people to collect samples and test themselves at home, addressing known barriers to facility-based testing. We aimed to measure the uptake of home HIV testing among Australian gay and bisexual men (GBM). Using national cross-sectional data from the Australian Gay Community Periodic Surveys, we assessed trends in home HIV testing among non-HIV positive GBM between 2018 and 2020. Overall, the use of home HIV testing was low, but slightly increased during 2018–2020 (from 0.3 to 0.8%, RR = 1.54, 95%CI = 1.23–1.92, p-trend < 0.001). Testing at home was more likely among non-HIV-positive GBM who were born overseas and recently arrived in Australia, at higher risk of HIV, and infrequent HIV testers. Given the greater use of home testing by men at higher risk of HIV, recent migrants and infrequent testers, all priority groups in Australia’s HIV epidemic, we recommend increasing access to HIV self-testing to enhance uptake in these and other groups of GBM.

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Increased targeted HIV testing and reduced undiagnosed HIV infections among gay and bisexual men

Cited by 9 publications

References 25 publications

The acceptability and usability of two HIV self‐test kits among men who have sex with men: a randomised crossover trial

The acceptability and usability of two HIV self‐test kits among men who have sex with men: a randomised crossover trial

Preferences for HIV Testing Services and HIV Self-Testing Distribution Among Migrant Gay, Bisexual, and Other Men Who Have Sex With Men in Australia

National Surveillance of Home-Based HIV Testing Among Australian Gay and Bisexual Men, 2018–2020: Uptake After Commercial Availability of HIV Self-Tests

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