Background
People with HIV can now expect a normal life expectancy so long as they are diagnosed and begin treatment in time (people are 10 times more likely to die within a year if diagnosed late). With most new infections coming from the undiagnosed, increased testing is also central to preventing the spread of HIV. Barriers and negative attitudes to testing in the UK contribute to unacceptably high levels of undiagnosed and untreated infection (24% of those infected, or 26,100 people) and late diagnosis
(42% of those diagnosed) 1 . Barriers include fear of testing positive, underestimating levels of personal risk, inconvenient clinic locations and hours, not knowing where to test and stigma around testing and using clinics.
Methods
To normalise testing and reduce undiagnosed infections, a nine-month pilot service offered free postal HIV tests and an online risk assessment through digital platforms.
This was delivered by HIV and sexual health charity Terrence Higgins Trust with the support of the Health Protection Agency (now Public Health England), as part of the activity of HIV Prevention England.
Free testing kits (using fourth generation antibody/antigen tests) were offered through a website. The recipient posted a finger prick blood sample to a lab which communicated negative results by text, with positive results given by phone. Before placing their order, people completed an online risk assessment that advised on how urgently they needed to test. Users could also sign up for email reminders to test. With supplies of tests limited, the service was promoted to the two groups with the highest
HIV prevalence: gay and bisexual men and African heterosexuals.
Results
During the nine-month pilot study the service sent out 9,868 tests (63.6% were returned). It was evaluated as highly acceptable, reaching those who are young, nonurban, high risk and not already using services; 33% of gay and bisexual men and 46% of Africans had never tested before. Users appreciated being able to avoid clinics (52%) or bypass inconvenient clinic times (47.7%) and 97% of those returning a test would recommend or use the service again. Positivity rates were 1.8% in gay and bisexual men and 3.6% in Africans, surpassing rates seen in clinics. The most popular way of hearing of the service (one third of all users) was through social media, especially via advertising on Facebook.
Discussion
With early diagnosis and treatment key to normal life expectancy and with most infections coming from the undiagnosed, new ways of influencing testing behaviour are needed. When backed by targeted promotion in the digital sphere, this new webbased service reached large numbers of high risk individuals not previously using clinics or testing regularly. Major barriers to testing were overcome, such as inconvenience and stigma associated with clinics. Targeted promotion on social media is the most successful and cost effective method of generating requests for tests.
Conclusion
Harnessing testing technology to digital platforms can make an important contribution to normalising HIV testing. High demand, high acceptability and significant numbers of positive diagnoses demonstrate the potential for home sampling to complement existing clinical testing services, reducing undiagnosed infection and preventing onward transmission within high risk populations. Following its pilot the service was successfully evaluated and has since become permanent.
References
1. HIV in the United Kingdom: 2014 report. Public Health England.
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