pilot of non invasive (oral fluid) testing for hiv within a community setting

Pilot of non-invasive (oral fluid) testing for HIV within a

community setting

Joseph Debattista* (1), Shaun Staunton (2), Frances Birrell (3), Nicole Roudenko (4), Bill Rutkin (5), Craig

Davis (3) Brisbane Sexual Health & AIDS Service, Northside

Health Service District (1); Queensland Association for Healthy Communities (2), Communicable Diseases

Branch, Queensland Health (3), Division of Immunology, Queensland Health Pathology Services, Royal Brisbane & Women’s Hospital (4), Sexual Health, HIV and HCV

Coordinator (Southern Area, Toowoomba Health Service

District) (5) Brisbane, Queensland, Australia.

Community response

• The community response very positive

• Originally planned to do two weeks worth of recruiting, but less than one week was needed

• 64 sessions were originally pencilled

in/only 32 sessions were needed

Identifying Recruiting Issues

• Recruiters noted that the majority of rejections were from young guys

• People in couples and groups seemed reluctant to take part due to others being around them (being in a group situation)

• People also refused on the grounds that they already knew their status

(positive and negative)

Test Results

• Participants didn’t get their HIV test results back

• To minimise any harms;

– Study pre-promotion

– Flyers about testing

– Sexual health clinic referrals

– Fast track blood testing process

– Health promotion staff available

– The study results released

Thanks to Frances Birrell from Communicable Diseases Branch, Queensland Health, for the following statistics and statistical analyses

Outline

• The study• Questions of interest• Test results profile• Participant characteristics• Risk factors• Limitations

Some Points about the Study

• Cross sectional (convenience sample)• 465 patrons from 7 venues

– Wet and dry SOPVs– Pubs/clubs

• Refusal: 24% - 42% across all venues• Occurred in Brisbane and Toowoomba

Questions of interest

• Among participants

– Prevalence of HIV

– Level of undiagnosed HIV infection

– Risk factors & testing patterns associated with serostatus

Subgroups – Reported status

• HIVpp – Reported self as being HIV positive/tested HIV positive (33 people)

• HIVnn – Reported self as being HIV negative/tested as being HIV negative (424 people)

• HIVnp – Reported self as being HIV negative/tested as being HIV positive (8 people)

HIV Prevalence (test results profile)

• 41participants ELISA positive/ Western Blot positive– 33 self reported as positive (HIVpp)

– 8 self reported as negative (HIVnp)

• 41/465=8.8% of total participants were HIV positive

• 8/465=1.7% participants (overall) were HIV positive and didn’t know

• 8/432=1.9% of those with negative self report were test positive

• 8/41 = 19.5% of people who were HIV positive didn’t know it

Age & Venue

Risk FactorHIVpp HIVnn HIVnp Total

n N % n N % n N % n N %

Number 33 465 7.1 424 465 91.2 8 465 1.7 465 100.0

median age 43.5 - - 35.0 - - 28.0 - - 36.8 - -

mean age 42.5 - - 36.4 - - 31.7 - - 35.6 - -

age range 22 - 60 - - 18 - 84 - - 22 - 44 - - 17- 84 - -

SOPV 16 33 48.5 135 424 31.8 1 7 14.3 152 464 32.8

pub/club 17 33 51.5 289 424 68.2 6 7 85.7 312 464 67.2

•Attend SOPV: HIVpp > HIVnn > HIVnp

•Median age: HIVpp > HIVnn > HIVnp

Most Recent HIV Test

• HIVpp: 67% tested with in last 6 months • HIVnn: 50% tested with in last 6 months• HIVnp all had test with in last 2 years (86% with in 6 months) - recent acquisition

Risk FactorHIVpp HIVnn HIVnp Total

n N % n N % n N % n N %

Number 33 465 7.1 424 465 91.2 8 465 1.7 465   100.0

last test < 1week 2 33 6.1 10 370 2.7 0 7 0.0 12 410 2.9

last test < 1- 4 weeks

9 33 27.3 41 370 11.1 1 7 14.3 51 410 12.4

last test 1 - 6 months

10 33 30.3 142 370 38.4 5 7 71.4 157 410 38.3

last test 7 -12 months

1 33 3.0 64 370 17.3 0 7 0.0 65 410 15.9

last test 1 – 2 years

2 33 6.1 59 370 15.9 1 7 14.3 62 410 15.1

last test 2- 4 years 2 33 6.1 30 370 8.1 0 7 0.0 32 410 7.8

last test > 4 years 7 33 21.2 24 370 6.5 0 7 0.0 31 410 7.6

Number of Partners in last 6 months

• HIVpp: ~40% ≥ 11 partners• HIVnn: ~20% ≥ 11 partners• HIVnp: ~14% ≥ 11 partners

Risk FactorHIVpp HIVnn HIVnp Total

n N % n N % n N % n N %

Number 33 465 7.1 424 465 91.2 8 465 1.7 465   100.0

number ptnrs - none

1 32 3.1 31 414 7.5 0 7 0.0 32 453 7.1

number ptnrs - 1 5 32 15.6 79 414 19.1 1 7 14.3 85 453 18.8

number ptnrs - 2 to 5

7 32 21.9 139 414 33.6 3 7 42.9 149 453 32.9

number ptnrs - 6 to 10

6 32 18.8 77 414 18.6 2 7 28.6 85 453 18.8

number ptnrs - 11 to 50

7 32 21.9 75 414 18.1 1 7 14.3 83 453 18.3

number ptnrs >50

6 32 18.8 11 414 2.7 0 7 0.0 17 453 3.8

Unknown number of ptnrs

0 32 0.0 2 414 0.5 0 7 0.0 2 453 0.4

Unprotected Sex

• Regular partner– HIVpp < HIVnn < HIVnp

• Casual partner– HIVpp > HIVnn > HIVnp

Risk FactorHIVpp HIVnn HIVnp Total

n N % n N % n N % n N %

Number 33 465 7.1 424 465 91.2 8 465 1.7 465   100.0

unptotected sex with regular partner

10 31 32.3 154 383 40.2 3 7 42.9 167 420 39.8

unprotected sex with casual partner

13 32 40.6 97 412 23.5 1 7 14.3 111 451 24.6

Knowledge of Partner Status

• Don’t know status of regular partner – HIVpp < HIVnn < HIVnp

• Don’t’ know status of casual partner– (HIVpp ~HIVnp) < HIVnn

Risk FactorHIVpp HIVnn HIVnp Total

n N % n N % n N % n N %

Number 33 465 7.1 424 465 91.2 8 465 1.7 465   100.0

know ptnr status (reg) +ve

11 25 44.0 10 334 3.0 0 6 0.0 21 365 5.8

know ptnr status (reg) -ve

5 25 20.0 193 334 57.8 3 6 50.0 201 365 55.1

know ptnr status (reg) -unknown

9 25 36.0 131 334 39.2 3 6 50.0 143 365 39.2

know ptnr status (cas) +ve

8 27 29.6 9 286 3.1 0 5 0.0 17 318 5.3

know ptnr status (cas) -ve

3 27 11.1 92 286 32.2 2 5 40.0 97 318 30.5

know ptnr status (cas) - unknown

16 27 59.3 185 286 64.7 3 5 60.0 204 318 64.2

Informed Partner of Status

• Informed none of regular partners– HIVpp < HIVnn < HIVnp

• Informed none of casual partners– HIVpp < (HIVnn ~ HIVnp)

Risk FactorHIVpp HIVnn HIVnp Total

n N % n N % n N % n N %

Number 33 465 7.1 424 465 91.2 8 465 1.7 465   100.0

Informed all regular partners of status

15 30 50.0 133 390 34.1 3 7 42.9 151 427 35.4

Informed some regular partners of status

10 30 33.3 114 390 29.2 1 7 14.3 125 427 29.3

Informed no regular partners of status

5 30 16.7 143 390 36.7 3 7 42.9 151 427 35.4

Informed all casual partners of status

8 31 25.8 85 383 22.2 0 7 0.0 93 421 22.1

Informed come casual partners of status

17 31 54.8 127 383 33.2 4 7 57.1 148 421 35.2

Informed no casual partners of status

6 31 19.4 171 383 44.6 3 7 42.9 180 421 42.8

Risk Factors – HIVpp (vs HIVnn+HIVnp)

Risk Factor Odds Ratio 95% Confidence Intervals p value

Attends SOPV 2.04 0.93 to 4.43 0.06

Unprotected sex with regular partner 0.71 0.29 to 1.62 0.38

Unprotected sex with casual partner 2.24 0.98 to 5.00 0.03

Knew HIV status of regular partner 25.93 8.28 to 79.70 0.00

Knew HIV status of casual partner 13.19 3.88 to 43.00 0.00

Informed regular partner of HIV status 2.91 1.06 to 9.92 0.03

Informed casual partner of HIV status 3.36 1.30 to 10.20 0.01

Had more than 11 partners in last six months

2.55 1.11 to 5.68 0.01

Limitations

• Cross sectional study • Opportunistic sample (not representative)

– Refusal: 24% to 42%

• Cannot make inferences beyond study group

But• May suggest hypotheses for more robust study

Summary - descriptive

• Median age: HIVpp > HIVnn > HIVnp • Venue type

– Attend SOPV: HIVpp > HIVnn > HIVnp

• Last HIV test– HIVpp: 67% tested within last 6 months (?other bloods tests, recent Dx)– HIVnn: 50% tested within last 6 months– HIVnp all had test within last 2 years (86% within 6 months)

• Partners in last 6 months (≥ 11 partners)– HIVpp: ~40%– HIVnn: ~20%– HIVnp: ~14%

Summary – descriptive (cont’d)

• Unprotected sex– HIVpp < HIVnn < HIVnp (regular)

– HIVpp > HIVnn > HIVnp (casual)

• Don’t know status of partner – HIVpp < HIVnn < HIVnp (regular)

– (HIVpp ~HIVnp) < HIVnn (casual)

• Informed none of partners– HIVpp < HIVnn < HIVnp (regular)

– HIVpp < (HIVnn ~ HIVnp) (casual)

AcknowledgmentsWe gratefully acknowledge the support of the laboratorystaff of the Division of Immunology, QHPS who performedthe assays, the staff and management of the participatingclubs and Sex on Premises Venues, the outreach workersfrom the Queensland Association for Healthy Communities(QAHC) who collected the specimens and patron surveys(Greg Jenner, Ben Wilcock, Michael King, Angela Yin,Susan Gobbart, Jasmine Linton, Mark Herriman, DavidDeloso, Scott Norman), Bill Rutkin for coordinating the Toowoombastudy, Garry Boddy of the CommunicableDiseases Branch, and most importantly, patrons whoGenerously participated. This study was funded by theCommunicable Diseases Branch, Queensland Health.