facilitating hiv testing and linkage to care - the uk experience

Fast-track the end of AIDS in the EU Practical evidence-based interventions

Facilitating testing and linkage to care – the UK experience

Cary James – Terrence Higgins Trust/ HIV Prevention England

Terrence Higgins Trust (THT) is the UK’s leading HIV and sexual health charity providing a wide range of services to more than 100,000 people a year.

The charity also campaigns and lobbies for greater political and public understanding of the personal, social and medical impact of HIV and sexual ill health.

HIV Prevention England is the national HIV prevention programme, funded by Public Health England and coordinated by THT.

Terrence Higgins Trust

UK Treatment Cascade

86% 94%96%

Diagnosed On treatment Undetectable

HIV in the UK 2016: Public Health England

1. Testing and linkage to care in clinical settings in London

2. National home-sampling service 3. Piloting free national self-testing service

Summary


Dean Street diagnoses1 in 9 of all HIV in the UK1 in 5 of all MSM in the UK1 in 4 of all HIV in London1 in 2 of all MSM in London

Source: Public Health England

Clinical testing


40% decrease in diagnosis

Almost exclusively MSM

0 200 400 600 800

HIV diagnoses 20152016

In the past year, Dean Street has adopted the San Francisco ‘RAPID’ model of offering immediate treatment

All HIV positive results offered an appointment with an HIV doctor within 48hrs

Important as 50% of new diagnoses are RITA positive/seroconverting so immediate treatment turns the ‘most infectious’ into ‘non infectious’

In the last 6 months 76% of people decided to start treatment at their first medical appointment.

Median time to starting ART is now 7 days (Compared to 21 days in San Francisco).

Median time to ‘undetectable’ was 58 days for people starting in July 2016 (Compared to 87 days in San Francisco).

Linkage to care model

That linkage to care and early initiation of treatment (along with PrEP) may have a large effect on HIV transmission in London – watch this space!

Possible lessons learned

Where home sampling can make a difference

Don’t perceive risk

Perceive risk but services inaccessible

Perceive risk but services

unacceptable

Perceive risk, services

accessible and acceptable but

won’t go

Courtesy of Dr Claudia Escourt

• HIV POSTAL SAMPLING

4th Gen, finger-prick home sampling: first pilot in Jan 2013.

FeasibleOver 50,000 kits orderedReturn rates of >50%

Acceptable96% recommend to a friend97% would use the service again“I didn’t want to attend STI service” – 52.2%“Clinic opening times are inconvenient” – 47.7%“Nearest clinic is too far” – 20.8%

Effective HIV positivity >1.5%

Cost Effective Total cost per test < €15.00

(including the test, lab costs, postage and marketing via social and digital media. )

THT home-sampling service 2013-2015

Socio-demographics of home sampling users*

THT homesampling GUM clinics

Aged under 25 35% 23%

MSM aged over 35 27% 36%

Major urban 39% 78%

Rural 25% 5%

*PHE Home Sampling Evaluation (12,485 kits)SJ Westrop, T Hartney, M Brady, A McOwan and A Nardone


AllNumber of kits ordered 55726Number of kits returned 29258Return rate 52.5%Reactive rate 1.1% (311)

National Home sampling results (Oct 15 - Dec 16)

Testing history (Nov 15 - Sep 16)


“I did the home test and can thoroughly recommend it. I’d

always been too scared to go to get tested elsewhere, so for a first timer like me it was much easier. My result was negative and as I was so relieved and happy I was

able to get over my fear and actually go and get tested at the

clinic for everything else.”

Service user

Home sampling can increase testing at scale and at low cost

It is highly acceptable to MSM and black Africans in England

Digital and social media are effective and cost efficient channels to generate orders

The service tests people who would not have tested otherwise

Some lessons learned from postal home sampling

Terrence Higgins Trust (THT) and Biosure UK designed and delivered a pilot of national HIV Home Testing which ran from June – August 2016.

5000 tests were made available to MSM and Black Africans Promotion via Facebook and dating applications Participants asked to report their results to THT

Self testing pilot

Self-tests are acceptable and desired Most users would tell THT their result if asked Most of those who tested positive linked

themselves into care before they were contacted

Like home sampling, social and digital media are powerful tools to generate orders and deliver tests.

Some lessons learned from self testing pilot

56 Dean StreetDr Alan McGowen

Public Health EnglandLuis GuerraAnthony NardoneValerie Delpech

Terrence Higgins Trust Dr Michael Brady Dominic Edwardes

HIV Prevention England team

Thank you [email protected]

Acknowledgements

mailto:[email protected]

facilitating hiv testing and linkage to care - the uk experience

Health & Medicine