HIV Self-Sampling

Dr Michael Brady Medical Director, Terrence Higgins Trust Dr Alan McOwan HIV and Sexual Health Consultant, 56 Dean Street Chelsea and Westminster Dr Anthony Nardone Centre for Infectious Disease Surveillance and Control

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Background

• An estimated 1 in 4 (24%) people living with HIV are undiagnosed (26,100) • HIV epidemiology in 2013 : • 42% of new HIV diagnosed with CD4 count <350 • ~½ of MSM diagnosed at first HIV test • Two populations most at-risk of HIV • Men who have sex with men (MSM) • Black-Africans • Need to increase HIV testing and frequency of testing, especially among MSM HIV in the United Kingdom: 2014 report (PHE)

HIV Self-Sampling Services

• HIV tests ordered on-line • 4 th generation dried blood spot / ‘tiny’ vial • 3 rd generation oral swab • Samples posted to laboratory • Individual informed of result • Negatives by text • Positives by phone • Referral to HIV service recommended / facilitated

4  PHE supported two services for 5 months of operation (Nov 13 – March 14) which has delivered: − 12,485 test requests − 6,593 returned (53%) − 92 new diagnoses (1.4% positivity)  Major issues highlighted from pilot phases − High volumes that can be managed through the internet − Different to clinic populations (younger and more rural) − Used by those at high risk due to testing and sexual behaviour − Linked to care − User satisfaction

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Geo-demography of users (MSM)

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Self-reported HIV testing history

25% 33% MSM Black African Heterosexuals 41% n=3270 Never tested Over a year ago Within the last year

Sexual partners in last year and testing history, MSM

Never tested (n=1088) None Over a year ago 1 (n=1350) 2-5 6-12 13+ Within the last year (n=832)

User Satisfaction with the National HIV Self-Sampling Services

Service HPE/THT (N=861) Dean Street (N=229)

8 Would you recommend the service to a friend expected to test

negative

Would you recommend the service to a friend expected to test

positive

I would use the service again 97% 65% 97% 96% 58% -

“I was really grateful that this existed as I don't think I would have gone to a clinic. I would have taken a lot of courage. an anonymous postal service made it so much easier. I would be really happy if this existed for other sexual health screening .”

McOwan

et al

BASHH/BHIVA conference 2014

Promotion of Postal Testing

Relationship to marketing (Phase 2)

2000 1800 1600 1400 1200 1000 800 600 400 200

National HIV testing week

0 18th Nov 2013 Dec 13 Jan 14

MARKETING

Feb 14 Mar 14 30th March Brady M

et al

BHIVA/BASHH conference 2014

Reactives via marketing method

Negative test result Reactive test result 20% 40% n=20 15% 30% 9% n=1,733 21% Dating apps It Starts with Me Campaign Twitter Facebook Leaflet Word of mouth THT staff Other social media Other Health services THT Newsletter

Cost per returned kit via marketing

• Cost per returned test on Twitter: £19.08

• Cost per returned test on dating sites: £10.75

£1.87

• Cost per returned test on Facebook:

Cost per reactive via marketing

• Cost per reactive on Twitter: £1,450 • Cost per reactive on dating sites: £1,854 £108 • Cost per reactive on Facebook:

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Conclusion

• Successful self-sampling services: • Large volumes with high return and positivity rates • ~¾ users had either never tested before or insufficiently • Closely linked to health promotion activity and social media • Accessing Black African populations remains a challenge • Costs much lower than clinic or outreach based services • Major contribution to plans to increase HIV testing • Adjunct to HIV testing in clinical services • Platform to which other STI tests could in future included

Acknowledgments:

Emmanuel Buenaventura, Dominc Edwardes, Cary James, Justin Harbottle and colleagues at Terrence Higgins Trusts & HIV Prevention England Alan McOwan and colleagues at Dean Street Clinic/Chelsea & Westminster Hospital NHS Foundation Trust Anthony Nardone, Samantha Westrop and colleagues at PHE