Abstract
BackgroundIn Liverpool, injecting drug users (IDUs), men-who-have-sex-with-men (MSM) and UK Africans experience a disproportionate burden of HIV, yet services do not reach out to these groups and late presentations continue. We set out to: increase testing uptake in targeted marginalized groups through a community and genitourinary medicine (GUM)-based point of care testing (POCT) programme; and conduct a process evaluation to examine service provider inputs and document service user perceptions of the programme.MethodsMixed quantitative, qualitative and process evaluation methods were used. Service providers were trained to use fourth generation rapid antibody/antigen HIV tests. Existing outreach services incorporated POCT into routine practice. Clients completed a semi-structured questionnaire and focus group discussions (FGDs) were held with service providers.ResultsBetween September 2009 and June 2010, 953 individuals underwent POCT (GUM: 556 [59%]; community-based sites: 397 [42%]). Participants in the community were more likely to be male (p = 0.028), older (p < 0.001), of UK African origin (p < 0.001) and IDUs (p < 0.001) than participants from the GUM clinic. Seventeen new HIV diagnoses were confirmed (prevalence = 1.8%), 16 of whom were in risk exposure categories (prevalence: 16/517, 3.1%). Questionnaires and FGDs showed that clients and service providers were supportive of POCT, highlighting benefits of reaching out to marginalised communities and incorporating HIV prevention messages.ConclusionsCommunity and GUM clinic-based POCT for HIV was feasible and acceptable to clients and service providers in a low prevalence setting. It successfully reached target groups, many of whom would not have otherwise tested. We recommend POCT be considered among strategies to increase the uptake of HIV testing among groups who are currently underserved.
Highlights
In Liverpool, injecting drug users (IDUs), men-who-have-sex-with-men (MSM) and UK Africans experience a disproportionate burden of HIV, yet services do not reach out to these groups and late presentations continue
This study presents findings from a study conducted in Liverpool, United Kingdom, to explore the feasibility and acceptability of point of care testing (POCT) for HIV among at-risk and marginalised groups; the success of this approach in reaching out to target groups and previously untested individuals; and to document key factors which impact upon the implementation of POCT for HIV in order to inform others wishing to expand POCT services
POCT was conducted in the department as opportunistic screening for individuals presenting for clinical care
Summary
In Liverpool, injecting drug users (IDUs), men-who-have-sex-with-men (MSM) and UK Africans experience a disproportionate burden of HIV, yet services do not reach out to these groups and late presentations continue. In Liverpool, three groups share a disproportionate burden of HIV infection: intravenous drug users (IDUs); men who have sex with men (MSM); and people of African origin[4,7]. This study presents findings from a study conducted in Liverpool, United Kingdom, to explore the feasibility and acceptability of POCT for HIV among at-risk and marginalised groups; the success of this approach in reaching out to target groups and previously untested individuals; and to document key factors which impact upon the implementation of POCT for HIV in order to inform others wishing to expand POCT services
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