News

Passing the test

Tracy Parish

10 October, 2018

A type of HIV self-test not yet available in Australia.

More than 40 countries in the world support self-testing HIV kits – Australia is not one of them. That’s about to change.

Enhancing the frequency of testing for HIV will be the goal of Burnet Institute’s new Flagship HIV project, with self-testing to be promoted as an effective, innovative and convenient option for people at risk of HIV.

Led by Burnet Institute’s Head of Public Health, Professor Mark Stoové, the project will address existing barriers to testing, and investigate ways to increase the coverage of self-testing and regular testing in ways that link people to care.

“Currently, the key priority in Australia is addressing undiagnosed HIV rates, and to achieve this we need to enhance the frequency of HIV testing,” Professor Stoové said.

“The rate of testing in Australia for gay men, the key risk population, has remained unchanged for five years, and less than 20 percent of those most at risk are adhering to national guidelines that recommend they test four times a year.

“This HIV self-testing project will target both prevention and the health impact of HIV. “We want to get people diagnosed as early in their infection as possible and, importantly, also make sure people access treatment as early as possible. People who are on treatment and virally suppressed do not pass the virus on to others and we know that early treatment leads to better health outcomes.”

In collaboration with clinical and community partners, the project will aim to focus initially in Victoria. HIV self-test kits and support will be accessible online, though the project will also investigate the efficacy and feasibility of distribution through community health services and clinics.

“The benefit of a website is that it can be highly interactive, and can provide instructions on how to use and read the tests” Professor Stoové said.

“These tests are very reliable, but they are not approved for diagnostic purposes, so it’s important that people who screen positive get a formal diagnosis from a clinician. “The website will include information about what a positive self-test means, and provide clear referral pathways for where people can access follow-up testing and support, and where they can go for immediate support and counselling through organisations like Thorne Harbour Health and Living Positive Victoria.

“This project will measure the uptake of self-testing, and compare outcomes like the frequency of HIV testing, and the time it takes for people to access treatment after a positive self-test with HIV specialist clinical services.”

While approval in Australia for the use of HIV self-testing kits is pending, ones that use oral fluid are considered unlikely to meet the Therapeutic Goods Administration (TGA)’s stringent guidelines. Instead the TGA is evaluating a finger-prick device endorsed for use in Europe and by the World Health Organization that’s similar to a diabetic blood sugar test. With future TGA approval likely, pre-approval implementation trials of this and other devices inform effective systems to manage and support people who choose to access self-tests.

“It is important that we prepare for the introduction of self-tests and have systems in place to maximise the prevention and clinical benefits of this new technology,” Professor Stoové said.

Among Victorians likely to benefit most from self-testing are people at risk of HIV who don’t have access to high caseload services that are situated primarily in Melbourne’s inner suburbs.

“People in rural Victoria or outer Melbourne often need to attend community general practices to access HIV testing and can sometimes experience stigma and discomfort in disclosing their risk practices,” Professor Stoové said.

“Our data shows that people who attend those services for HIV testing attend less regularly for testing and are on average diagnosed later in their infection.

“We’re also seeing increases in HIV among migrant communities, particularly young Asian gay men who also experience a range of barriers to negotiating the health system in Australia and testing regularly.”


The HIV diagnosis and care cascade estimates, 2015–2017

In Melbourne extra pressure has been placed on high caseload clinics since the listing of HIV prevention medication PrEP on the Pharmaceutical Benefits Scheme in April 2018. Managing the dispensing and renewal of scripts for PrEP every three months has created capacity issues at some HIV specialist clinics. Self-testing may also assist gay men who find it difficult to test up to four times per year. Instead they can intermittently use self-tests coupled with regular clinic appointments.

Long-term the project will create the infrastructure, support and a platform for self-testing that can be maintained by government, the community and clinical partners.

“We are involving the community throughout this implementation program and building in key features that will make the program sustainable and acceptable to the community in decades to come,” Professor Stoové said.

“Generating a body of evidence that will help with the implementation and reach of important programs in a real-world setting is a really exciting opportunity.”

  • Click here for the full Summer 2018 edition of IMPACT

Contact Details

For more information in relation to this news article, please contact:

Tracy Parish

Executive General Manager, Marketing and Communications

Telephone

+61385062321

Email

tracy.parish@burnet.edu.au

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