Point‐of‐care HIV testing for men who have sex with men in sexual health clinics in Sydney, New South Wales

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Embargoed until 2017-11-30
Copyright: Conway, Damian
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Abstract
Men who have sex with men (MSM) are disproportionately affected by the HIV epidemic in Australia, accounting for two-thirds of newly diagnosed infections annually. Rates of HIV infection in MSM have been increasing over the last ten years; however, only a minority of men test for HIV at the recommended frequency. Frequent testing is essential for early diagnosis and initiation of HIV treatment as prevention; and implementing point-of-care HIV testing has been proposed as a method to make testing quicker and more convenient. When this research commenced in 2011, no point-of-care HIV tests had been approved for clinical use in Australia and there had been very limited research into this approach. Hence, the aim of this research was to provide new information to inform policy development on HIV testing, and service provision, for MSM in Australia. This thesis is based on the Sydney Rapid HIV Test Study, which evaluated the use of the new fourth generation Alere Determine HIV Ag/Ab Combo rapid test for screening MSM at four sexual health clinics. A review of the relevant literature is followed by four published journal articles arising from this study; providing new information on barriers to HIV testing among MSM, and the acceptability of point-of-care testing to patients and clinic staff. Psychological and structural barriers to testing were common among clinic-based MSM; with most men reporting that they preferred point-of-care testing to conventional laboratory testing for their next HIV test, and would test more often if point-of-care testing was available. Staff reported high acceptance of point-of-care testing at baseline, which increased with experience of point-of-care testing. Finally, compared with laboratory fourth generation HIV immunoassays, the Determine Combo rapid test performed well in cases of established HIV infection, but was less sensitive in early infection (missing one-third of these cases). These findings support implementation of point-of-care HIV testing in Australian sexual health clinics, demonstrating that its use for screening MSM is feasible and acceptable to patients and staff in this setting. However, point-of-care testing should be performed with parallel laboratory testing in this population of MSM to avoid early HIV infections being missed.
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Author(s)
Conway, Damian
Supervisor(s)
Guy, Rebecca
Holt, Martin
Grulich, Andrew
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Publication Year
2015
Resource Type
Thesis
Degree Type
PhD Doctorate
UNSW Faculty
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