Implementation and Operational Research: Convenient HIV Testing Service Models Are Attracting Previously Untested Gay and Bisexual Men: A Cross-sectional Study.

Abstract

HIV testing is a cornerstone of the treatment as prevention approach. We assessed which HIV testing service delivery models were more likely to attract untested or infrequent tested gay, bisexual and other men who have sex with men (GBM). We compared demographics, risk behavior, and HIV testing history among new GBM clients attending 3 different HIV testing service models (fast-track Xpress clinic, fixed-site community-based service, and time-limited community-based shopfront) between August 2013 and May 2014. We used bivariate and multivariate regression to assess factors (including service model) associated with being untested or infrequent testers (not tested within the past 12 months). Overall, 1704 new GBM attended the services; 19% were untested and 41% were infrequent testers. Across the services, there were significant differences in demographics, risk behavior, and HIV testing history. The overall HIV seropositivity was 1.2% (95% confidence interval: 0.8% to 1.9%) and sexually transmitted infection positivity was 12.4% (95% confidence interval: 11.6 to 17.2) with no significant differences across services. Factors independently associated with being untested were attendance at the 2 community sites, younger age, being born in Asia, living in North Sydney, being bisexual and reporting fewer male sexual partners. Factors independently associated with infrequent testers were attending the fast track Xpress clinic, being older, being born in Asia, and reporting fewer male partners. The findings suggest both community and fast track testing service models are important to increase HIV testing among GBM with a similar yield of HIV diagnoses at the 3 services. The community models reached more untested men and the fast track model more infrequent testers.