The following should be read in alongside the Challenge Brief interview and other supporting materials located on UTS Online. “Since the advent of highly active antiretroviral therapy (HAART), human...

The following should be read in alongside the Challenge Brief interview and other supporting materials
located on UTS Online.
“Since the advent of highly active antiretroviral therapy (HAART), human immunodeficiency virus (HIV) can be considered a treatable condition. In Australia in 2010, 40% of people had their HIV diagnosed late, where late is defined as CD4 Rapid HIV testing is a new community-based service for men who have sex with men in Sydney. There are a number of sites which NSW Health either run or jointly-run with ACON.
There are some private providers who provide this service in the context of a large general practice already – however, in the main, the public provision of these services is physically isolated from the main sexual health service (which is based at Sydney Hospital).
One of the private providers is the Taylor Square Private Clinic. On their website they have the following information about rapid testing:
Clinic director Dr Robert Finlayson adds that trialing new methods of making testing more accessible falls in line with New South Wales Health’s ‘Treatment as Prevention’ policy.
“It is estimated that there are over 8,000 people in Australia living with HIV who don’t know [they are HIV-positive]. Several studies have shown that having to have a blood test and come back for the results at another time are perceived as barriers to testing by many people in high risk groups.”
“So if we can have rapid testing or any other method that is going to lessen the barriers to testing hopefully we can identify more people who have HIV but currently don’t know. Some estimates are that up to one in five men who have sex with men are HIV positive, but don’t know it.”
WHAT YOU NEED TO KNOW ABOUT RAPID HIV TESTING
Like laboratory-based HIV tests, rapid HIV tests have a window period. The window period is the time between being infected with HIV and the appearance of detectable antibodies to the virus.
While most people will produce antibodies to HIV in less than six weeks from infection, the window period for rapid tests is three months. This means that if you have had a recent exposure to HIV, the rapid test may not detect an infection.
There are three types of results that you could get from a Rapid HIV Test:
1Charlotte Bell, Russell Waddell, Nicola Chynoweth, ‘Consider HIV Testing for HIV and HIV indicator diseases’, Australian
• Non-reactive – HIV antibodies were not detected in the sample. It’s important to note that people in the ‘window period’ might also receive a non-reactive result.
• Reactive – HIV antibodies were detected in the sample, but this result needs to be confirmed with laboratory based blood testing. As rapid HIV tests are very sensitive, a reactive response can be triggered by a number of things not HIV related. If a reactive response occurs, there is a small chance that this reactive response is a false response (not related to HIV).
• Invalid – there is a small possibility that the rapid test may show an invalid response. This result is not an indication of a person’s HIV status. In this situation a person will be offered a repeat rapid test.
Remember that all these results are only preliminary and blood will still need to be sent to the laboratory for full testing.2
One significant concern is the question about integration. On the one hand, the service is designed to achieve some significant and difficult targets for the rapid reversal of the rise in HIV which has been measured in NSW in the past few years. So too does it have some goals in relation to reversing the very significant rise in other STI’s – including Chlamydia. NSW Health’s HIV Strategy 2012-2015: A New Era can be found here. The service alone cannot achieve this. It must work with other stakeholders in the sector as well as finding a way to sustain its work – and to ensure patients continue to access both its rapid testing service to ‘know their status’ but then to access their own primary care services in the form of a local GP.
Timmy has mentioned a few issues which arise in relation to accessing GP services for patients in the rapid testing service – both for those who are diagnosed with an STI (including, but not limited to HIV) and those who are found not to have HIV.
CHALLENGE:
With the rapid testing sites now working well, a chance for better integration between these stand-alone sites and the rest of the primary care system has presented itself.
Some questions which Timmy has asked us to focus on include how the service can work more effectively to connect or re-connect patients into their current or a new GP. He wants also this to be a way of providing some better flows of information both ways between general practice and the services.