Utilisation of novel methodologies to engage 'hard to reach' clients in health promotion and screening, in rural and regional areas

This following provides a detailed summary regarding the case of HIV screening and health promotion within a regional/rural community in Queensland, with higher self-reported rates of stigma and discrimination. Information is provided regarding the community engagement and communication strategies employed to promote this novel screening initiative; use of community-based online technologies to promote participant recruitment, and use of respondent-driven sampling to increase engagement with hard to reach and socially isolated members of the target group. Use of peer-health promotion officers, a discrete screening environment, bringing the mobile service to the key target groups and geographical regions; onward linking and integration with mainstream health services and models of care; and direct collaborative partnering with key community organisations will be further discussed and are pivotal to the feasibility and acceptability of these types of initiatives. Broader applications to other health areas will also be discussed

Novel HIV testing during health promotion outreach: a qualitative analysis of field notes by peer-testers

Introduction: Significant health disparities persist regarding new/late HIV diagnoses among HIV sub-Saharan African communities in Australia . A wide range of personal and cultural beliefs and practices significantly influence HIV risk and prevention both within Australia and during return visits to countries of origin. Method: A community forum was conducted which included 23 male and female adult members of African community agencies/networks and stakeholders. The forum was facilitated by cultural workers and an experienced clinician/researcher. The forum consisted of small and large group discussions regardingkey topics with responses transcribed verbatim. Thematic analysis was utilised to analyse data collected at the forum. Ethics approval was obtained. Results: Issues of stigma and denial, social norms, tradition and culture permeated perceptions and beliefs regarding HIV prevention and transmission among African Australians, particularly in relation to return travel to countries of origin. Conclusions: The role of international travel as a risk factor for HIV acquisition requires increased examination and review, as do the role of the GP and Pre-exposure prophylaxis (PrEP) as responses to that risk. Further assessment of PrEP as an appropriate and feasible intervention within the community is needed with careful attention given to negative community perceptions and its potential impact on individuals

Substance use at sex on premises venues among GBMSM (gay, bisexual and other men who have sex with men)

Introduction and Aims Sex on premises venues (SOPV) for GBMSM (gay, bisexual and other men who have sex with men) provide novel contexts for more sexually adventurous practices, including recreational substance use. This sub-group provides unique insight into experiences, sexual activity and substance use patterns of GBMSM and peer health workers. Design and Methods Participants were recruited as part of a larger HIV peer-testing project providing innovative HIV and STI asymptomatic screening. Health promotion was provided late on Friday and Saturday nights during themed sex parties to engage GBMSM in rarely studied after-hours context. Participants included venue patrons (n = 4) and peer testers (n = 5). Trained researchers (clinicians) conducted interviews with verbal consent provided. Thematic analysis was used to identify themes regarding substance use and harm reduction within these settings. Ethics approval was obtained. Results Four main themes (with sub-themes) were identified. 1) Substance use in the venues (e.g. amyl, alcohol, crystal, use in combination, desire to avoid); 2) How substances transform experiences (e.g. disinhibition, social enhancement); 3) How substances transform sexual experiences (e.g. enhances sexual performance, more adventurous); and 4) Harm reduction strategies (e.g., current practices, recommendations). Discussions and Conclusions Group sex parties at private clubs provide an opportunity for GBMSM to explore aspects of their personal/sexual identity. Recurrent themes suggest a culture that values health promotion despite engaging in activities associated with a higher risk for acquiring HIV or an STI. Innovative models of care require new health promotion hours and settings. Implications for Practice or Policy (optional) The findings demonstrate how peer-testers can support increasing awareness and promotion of harm reduction strategies among this subgroup within SOPV having implications for the development of policy and health promotion interventions

PoCT (point of care) HIV/STI testing at after-hours SOPV (sex on premises venues) theme parties

Background: Sexual ‘theme parties’ have become more popular among MSM (men who have sex with men) over time. They are typically attended by more ‘sexually adventurous’ MSM and associated with alcohol/other drug use. These factors may constitute heightened risks for HIV/STI transmission. Operating a regular, rapid HIV/STI testing service during theme parties (within a high-risk setting), represents a novel approach to health promotion and more accessible testing. This research sought to establish ‘proof of concept’, and evaluate the uptake and feasibility/acceptability of routine HIV/STI testing for MSM in a novel outreach environment. Method: Weekly HIV/STI PoCT (Alere, UniGold) was offered by trained peer-testers on Friday and Saturday nights from 9pm-midnight, in a private room at the venue. Patrons requesting tests were asked to complete an evaluation survey after testing. Verbal consent was provided and ethics approval was obtained for the evaluation. The testing processes were per TGA guidelines. Results: To date, 122 MSM have participated in PoCT (majority identified as ‘gay’; average age 36, range: 18-66) over a six month period (indicating 4 reactive syphilis tests; nil reactive HIV); recruited via information within the venue and social media). Salient findings indicate: All (100%) participants reportedly felt comfortable with the community outreach testing; 96% reported peer-led testing would increase the frequency of testing; 20% ‘would not have had a test’ if the service did not exist; and 34% reported to have ‘never had’ an HIV test. Further qualitative comments reflecting acceptability included: accessibility; feeling comfortable; easy and quick testing—conducted by friendly and ‘relatable’ staff members. Secondary analyses regarding socio-demographic features associated with testing patterns, substance use, sexual activity and harm reduction strategies will also be highlighted. Conclusion: This project has demonstrated acceptability and feasibility within a key MSM sub-group—regarding novel health promotion delivered by a peer-based PLHIV organisation. Implications for further health promotion efforts and future research with sexually adventurous MSM will be discussed in light of main findings. Rapid PoCT technologies foster opportunistic HIV/STI testing uptake amongst MSM in a high-risk setting, and create opportunities for qualitative follow-up; the research will inform the lens through which drug use among gay men and other MSM is contextualised within a sexual context

HIV Point of Care Testing (PoCT) at late-night sex on premises venues (SOPV) for gay and bisexual men and other men who have sex with men (GBMSM): a mixed methods analysis

The aim of this study was to establish ‘proof of concept’ for a novel approach to HIV and STI testing at a sex on premises venue (SOPV) for gay and bisexual and other men who have sex with men (GBMSM) during late night group sex theme parties. A mixed-methods approach was used, and the study aimed to: (1) Build upon existing SOPV funded service delivery and establish ‘proof of concept’ for this unique setting within an SOPV; (2) evaluate the uptake and feasibility/acceptability of routine HIV/STI testing for GBMSM during theme parties in SOPV; and (3) identify beliefs/perceptions regarding this health promotion activity and venue suitability. The characteristics of patrons utilising PoCT (Point of Care Testing) were established to help further reach potentially stigmatised, highly sexually adventurous GBMSM. The findings support further PoCT endeavours within MSM communities to target harder to reach communities to reduce the rate of new transmissions of HIV. Findings can inform future health promotion, screening and interventions, as well as to identify a successful method to engage harder to reach GBMSM that need further focused targeting for HIV and STI testing to reduce transmission

Point-of-care testing (POCT) for HIV/STI targeting MSM in regional Australia at community ‘beat’ locations

Abstract Background Innovative health promotion strategies are needed to improve access to HIV testing among regional people in Australia, particularly for men who have sex with men (MSM). This project aimed to establish proof of concept for point-of-care-testing (POCT) via a mobile van clinic at community ‘beat’ locations. Surveys evaluated client satisfaction, characteristics and testing preferences among ‘early adopters’. Sequential mixed-methods approach was used which included secondary qualitative analysis of field notes written by peer-testers (i.e., trained lay providers from the key population being targeted; to extend the contextualise the pilot evaluation), documenting barriers/facilitators and innovations, per action research and to guide recommendations for future health promotion initiatives. Methods A POCT ‘proof of concept’ project (2, 3-hourly sessions/week; 20 weeks) was delivered in a regional town by peer-testers using a mobile clinic van, recruited by geosocial ‘apps’ targeting MSM. Clients completed surveys regarding demographics, and testing satisfaction, frequency and preferences. Peer-testers completed detailed field notes for each session including client characteristics and impressions, salient events, concerns and recommendations. Results The program resulted in 34 online health promotion conversations with MSM and 34 POCT tests (19 HIV, 15 Syphilis; 18 unique client visits; 17 identified as MSM, with 1 heterosexual female. Rates of satisfaction among early adopters of POCT was high. Analysis of field notes revealed three major themes: 1) Practical challenges; 2) Barriers to engagement; and 3) Recruitment method/project promotion. Conclusions Amongst early adopters satisfaction was high, with 47% of clients reported infrequent testing (over 12 months ago) or having ‘never tested’. No tests were reactive. Challenges associated with this health promotion initiative and recommendations for future HIV testing promotion and programs were outlined

Knowledge and awareness of HIV self-testing among Australian gay and bisexual men: a comparison of never, sub-optimal and optimal testers willingness to use

This paper explores the willingness to use and pay for HIV Self-testing (HIVST) among Australian gay and bisexual men (GBM). Bivariate and univariate multinominal logistic regression of data from an online survey was performed. Thirty-one (13%) had never HIV tested and 41.9% (88) were testing sub-optimally by Australian guidelines. Half (58.4%, 136) had never heard of HIVST, however, 56.2% (131) reported willingness to use HIVST, with sub-optimal (OR=2.13; p < 0.01) and never-testers (OR=2.01; p < 0.10) significantly more likely to do so than optimal-testers. Most were confident (51.7%, 119) or somewhat confident (29.1%, 67) accessing support following a reactive result, however, never-testers were significantly less confident compared to previous testers (OR=3.47; p< 0.05). Less than a quarter (23.6%, 57) were willing to pay for a kit with AUD$15 (R = 0.9882) the estimated preferred price. This research confirms that HIVST is an important and accepted adjunct to established HIV testing modalities, particularly among sub-optimal and never-testers and that online (61.6%, 143) or clinic-based (61.6%, 143) dissemination are preferred. Research examining how best to disseminate HIVST in a range of safe and effective models needs to continue to ensure HIVST is part of a comprehensive strategy that facilitates usage and linkages to care