Introduction Increasing the frequency of HIV testing among populations at risk, such as MSM, enables earlier diagnosis which maximises the preventive effect of antiretroviral therapy. The requirement to attend a clinical consultation to obtain HIV testing may act as a barrier to increasing the frequency of testing and adds to the cost of additional tests.
Methods Randomised controlled trial (RCT). MSM attending Melbourne Sexual Health Centre for HIV testing were randomised 1:1 to an intervention allowing HIV/syphilis testing at a network of around 300 pathology centres and in the clinic, without requiring another consultation for 12 months. Controls had to attend a consultation for each HIV test as usual. During the study, both groups received four text messages recommending frequent testing. The primary outcome was the incidence of HIV testing over 12 months.
Results Of 443 men referred to the study, 13 declined participation, 8 were excluded because they were leaving Victoria and 422 were randomised. Three had positive HIV tests and were excluded from the analysis. Of 208 controls, 202 (97.1%) and 200 of 211 (94.8%) intervention group members were followed to 12 months. The intervention group had 453 tests in 205.6 person-years, incidence rate 2.2 (95% confidence interval (CI): 2.0, 2.4) tests per year and the control group had 432 tests during 204.0 person-years, incidence 2.1 (95%CI: 1.9, 2.3) tests per year, incidence rate ratio (IRR) 1.04 (95%CI: 0.89, 1.2) p=0.63. The intervention group had 101 of 453 [22.3% (95% CI:18.5%, 26.4%)] tests at pathology centres without a clinical consultation.
Conclusion In this RCT, MSM who were allowed HIV/syphilis testing outside of clinical consultations did not test more frequently than controls who had to attend a consultation for every test. Making testing more convenient may not be sufficient to achieve increases in testing frequency. However more than one in five tests in the intervention group did not require a clinical consultation, reducing service costs.
Trial registration: ACTRN12614000760673