Community Testing

M Clinic Reflections July 2010 – May 2012

Michael Atkinson

Overview

1. Rationale for M Clinic

2. What we have found

3. Implications

Rationale for M Clinic 1. Syphilis Outbreak mid 20062. At the same time - high level of asymptomatic

STIs in WAAC Sauna Clinic3. PGCPS’s show: testing poor + Increasing UAIC 4. General unmet supply of testing services 5. Seen as a way to improve ‘testing culture’ 6. WAAC survey found guys wanted peer based

service but more discrete 7. Clinic provided a tangible hook to engage men

in education

What have we found?

Clients

1. 1310 clients since July 2010

2. >85% of clients have returned at least once

3. Place of residence: 60% within 20km of CBD, 40% outer suburbs & state wide

4. Majority hear about us though word of mouth

5. Place of last test: Majority from GP, then tertiary sexual health service

6. Increasing number of HIV positive clients

Clients by age

0

100

200

300

400

500

600

Under 21 years

21 - 30 years

31 - 40 years

41 - 50 years

51 - 60 years

61 + years

Age distribution

HIV Diagnoses (22 months)

• 18 HIV diagnoses• 14/18 incident cases• Over half had co-current STIs• All but 1 contracted in Australia• 9 Overseas born• UAI main mode of transmission

HIV Yield by Age

0

10

20

30

40

50

60

Under 21 years

21 - 30 years

31 - 40 years

41 - 50 years

51 - 60 years

61 plus years

Testers %

HIV Yield %

Data provided by: Epidemiology and Surveillance Program, Communicable Disease Control Directorate, WA Department of Health

HIV & Syphilis Yield by Age

0

10

20

30

40

50

60

Under 21 years

21 - 30 years

31 - 40 years

41 - 50 years

51 - 60 years

61 + years

Clients %

HIV Yield %

Infectious Syphilis Yield %

Data provided by: Epidemiology and Surveillance Program, Communicable Disease Control Directorate, WA Department of Health

Interpretation

1. The sexual health service gap in WA is experienced most by younger people (21-30 years) who require convenient, fast testing

2. The older age bracket (51-60) may have decided that risky sexual practices are part of the deal as you get older.

WA HIV notifications – MSM 01 July 2011 to 31 March 2012

Diagnosing Clinic Total Total%

GPs 16 39%

M Clinic 12 29%

General sexual health clinics (n=3 clinics) 7 18%

Hospital diagnoses (n=4 hospitals) 5 12%

Private Infectious Diseases Consultant 1 2%

Grand Total 41 100%

WA Trends

Since Establishment

M Clinic has had the highest number of MSM HIV notifications from a single clinic in WA

Since November 2011

M Clinic has diagnosed 50% of new HIV diagnoses amongst gay men in WA

Compared with other settings in WA:

M Clinic clients are:

• More likely to have contracted HIV in Australia

• More likely to have been tested because of risky behaviour

• More likely to present for testing within one year of transmission

Information provided by: Epidemiology and Surveillance Program, Communicable Disease Control Directorate, WA Department of Health

Implications

• Positive response from the community

• Potential to expand services to a condom-weary group

• Potential to incorporate innovations such as Point of Care testing

• Model attractive to under 30s

• Potential to develop other strategies to engage this elusive target group

• Large number of HIV diagnoses

• Model provides opportunity for a holistic and integrated response at diagnosis – thus reducing long term impact

• Potential to expand the range of services to HIV positive people

• Shift towards community based screening in WA

• Cost shifting

Implications cont…

• The model facilitates early diagnoses of HIV & STIs

• Potentially decreasing downstream infection

• Complements ‘treatment as prevention’ model

• M Clinic sees different clients to other clinics

• People prefer to talk to a peer about risk behaviour

• We are diagnosing people that may not have tested

• Rich source of data - Research potential

• Western Australian Sexual Health Services Survey – Kirby Institute

• HIV Sero-converters Study (Recent HIV Spike) – Kirby Institute

Acknowledgements

• Byron Minas, Lisa Bastian and the supportive team at CDCD, WA Department of Health

• Mark Reid, Tony Bober, Garry Kuchel, Nadine Toussaint and all the peer educators at WAAC

• Dr Lewis Marshall, Dr Paul Effler and the four other M Clinic doctors

• The gay community and clients who have embraced and supported our clinic