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SJ Westrop 1 , C James 2 , D Edwardes 2 , M Brady 2 , R Gillespie 2 , ON Gill 1 and A Nardone 1

Testing history and risk behaviour of individuals requesting an HIV test through an online self-sampling service. SJ Westrop 1 , C James 2 , D Edwardes 2 , M Brady 2 , R Gillespie 2 , ON Gill 1 and A Nardone 1 1 Public Health England and 2 Terrence Higgins Trust. Background.

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SJ Westrop 1 , C James 2 , D Edwardes 2 , M Brady 2 , R Gillespie 2 , ON Gill 1 and A Nardone 1

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  1. Testing history and risk behaviour of individuals requesting an HIV test through an online self-sampling service SJ Westrop1, C James2, D Edwardes2, M Brady2, R Gillespie2, ON Gill1 and A Nardone1 1Public Health England and 2Terrence Higgins Trust

  2. Background • 98,400 people living with HIV in the UK1 • 1 in 5 people living with HIV (21,900) unaware of their infection1 • Increasing HIV testing is a major component of HIV prevention; by reducing number of undiagnosed • HIV disproportionally affects: • men who have sex with men (MSM): ~1 in 201 • black African heterosexual men: ~1 in 381 • black African heterosexual women: ~1 in 201 • Current recommendations for frequency of testing are: • MSM: at least once every 12 months, or every 3 months if having unprotected sex with new or casual partners • black African men and women: test if having unprotected sex with new or casual partners • 1HIV in the United Kingdom: 2013 report. Public Health England

  3. Service provision • HIV tests ordered on-line • 4th generation dried blood spot HIV test • Samples posted to PHE lab • Negative results by text • Reactive results by phone • Referral by THT to HIV service recommended • Consent for follow up to confirm access to care

  4. Service provision Media Campaigns Local campaigns National campaigns Individuals request kit from internet HIV Self-Sampling Service • Management web site (incl. marketing) • Fulfilment • Pathology • Results Management

  5. Study aims and objectives Aim To describe the users of the HIV self-sampling service, in order to evaluate the effectiveness of reaching target populations by investigating: • Testing history • High-risk sexual behaviour

  6. Methods • National service; Jan-Sep 2013 and Nov 2013-Mar 2014 • 17,629 ordered; 10,410 returned (59.0%); 146 positive (1.4%) • Collected extra data from 3522 requests • 16 day period from 27-Feb-14 to 14-Mar-14 • Clients ordering kits provided: • Demographic information; ethnicity, gender, sexuality • HIV testing information; time since last HIV test • Sexual behaviour information; number of sexual partners, unprotected sexual partners, frequency of sex under the influence of alcohol or drugs • Pearson's χ2 test determined associations

  7. Target groups black African heterosexuals Heterosexual women Heterosexual men 85% 88% n=58 n=79

  8. Target groups men who have sex with men

  9. Testing history men who have sex with men 25% 33% 41% n=3270

  10. Testing history black African heterosexuals 13% 40% 47% n=112

  11. Sexual partners past 12 months 65% 54% 80% n=3270 n=49 n=63

  12. Sexual partners and testing historymen who have sex with men (n=1088) (n=1350) (n=832) Total n=3270 χ2=123.80, p< 0.001

  13. Sexual partners and testing historyblack African heterosexual women (n=25) (n=37) (n=7) Total n=63 χ2=17.57, p= 0.007

  14. Conclusion • Self-sampling service enables large numbers from target populations to test quickly and easily • Significant proportions of clients had never tested before • black African heterosexual women with more sexual partners had not tested as recently; higher risk not accessing testing • MSM with more sexual partners had tested more recently; more convenient to use self-sampling service • The self-sampling service represents a novel, effective method of expanding HIV testing to individuals at high-risk of infection, who otherwise may not test

  15. Acknowledgements PHE Laboratory Manchester Dave Ellis Ken Mutton Terrence Higgins Trust Fizza Qureshi Emmanuel Buenaventura Service users

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