Rapid community-based HIV testing is both feasible and reaches gay men with a high risk of the infection, investigators report in a study published in the online edition of Sexually Transmitted Infections. The research, conducted in Brighton, UK, showed that 24% of men using the community-based testing facility had never previously tested for HIV. Preliminary results were presented to a conference in 2006 and reported here.
However, the investigators note that community-based testing facilities do not screen individuals for other sexually transmitted infections, and the cost of each HIV test conducted at such a facility is the same as that for a full sexually transmitted infection screen at a traditional genitourinary medicine (GUM) clinic.
Late diagnosis of HIV is a major concern in the UK, and it is estimated that 44% of gay men have never had an HIV test.
In 2004, the Department of Health set up a number of pilot projects to evaluate the feasibility of offering HIV tests in community-based organisations. One of these projects, called Fastest, was based at Terrence Higgins Trust (THT) in Brighton and offered HIV tests to gay men.
Investigators wished to find out if the gay men using this service differed from those attending traditional HIV and sexual-health testing facilities at GUM clinics in terms of their demographics, sexual behaviour, sexual-health and HIV testing history, HIV prevalence and stage of HIV infection.
The study included 280 gay men tested in the community and 187 who attended a GUM clinic. All these patients completed questionnaires providing background information about their demographics and risk and HIV/sexual-health testing history.
Men testing at THT were significantly younger than those testing at the GUM clinic (33 years vs 36 years, p = 0.02). They were also significantly more likely to have never had an HIV test before than those having an HIV test at a GUM clinic (27% vs 15%, p = 0.01). However, when the investigators controlled for age, this difference ceased to be significant.
Similar proportions of men using the two HIV testing facilities reported unprotected anal sex in the previous three months (THT, 46% vs GUM, 47%).
However, men testing at the community-based organisation were significantly less likely to test HIV-positive (3%) than men using GUM services (9%, p = 0.007).
The stage of HIV infection did not differ between the men diagnosed using the two facilities.
“Brighton Fastest successfully tested high risk men who have sex with men with a substantial minority being untested”, comment the investigators. “Brighton Fastest increases choice for men who have sex with men wanting to test for HIV and fits well with moves to deliver sexually transmitted infection care in the community.”
However, the investigators note that rapid HIV testing facilities cannot offer screens for other sexually transmitted infections. This is of concern as other research has shown that many gay men diagnosed with HIV have concurrent sexually transmitted infections.
Furthermore, the researchers note “the estimated cost of a test at Fastest is similar to that of a sexually transmitted infection screen (HIV/syphilis/Chlamydia/gonorrhoea/hepatitis) under the national GUM tariff.” Given this, they suggest that: “Commissioners must balance these issues of choice, value and quality when reviewing service configurations.”