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Open Access Research article

Feasibility and acceptability of point of care HIV testing in community outreach and GUM drop-in services in the North West of England: A programmatic evaluation

Peter MacPherson12*, Anu Chawla3, Kathy Jones4, Emer Coffey5, Vida Spaine1, Ian Harrison5, Pauline Jelliman6, Penelope Phillips-Howard7, Caryl Beynon7 and Miriam Taegtmeyer1

Author Affiliations

1 Clinical Group, Liverpool School of Tropical Medicine, Pembroke Place, L3 5QA, Liverpool, UK

2 Wellcome Trust Tropical Centre, University of Liverpool, Pembroke Place, L69 3GF, Liverpool, UK

3 The Liverpool Specialist Virology Centre, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Prescot Street, L7 8XP, Liverpool, UK

4 Liverpool Centre for Sexual Health, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Prescot Street, L7 8XP, Liverpool, UK

5 Liverpool NHS Primary Care Trust, 1 Arthouse Square, L1 4AZ, Liverpool, UK

6 Liverpool Community Health NHS Trust, Wilkinson Place, L13 1FB, Liverpool, UK

7 Centre for Public Health, Liverpool John Moores University, 15-21 Webster Street, L3 2ET, Liverpool, UK

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BMC Public Health 2011, 11:419  doi:10.1186/1471-2458-11-419

Published: 1 June 2011

Abstract

Background

In Liverpool, injecting drug users (IDUs), men-who-have-sex-with-men (MSM) and UK Africans experience a disproportionate burden of HIV, yet services do not reach out to these groups and late presentations continue. We set out to: increase testing uptake in targeted marginalized groups through a community and genitourinary medicine (GUM)-based point of care testing (POCT) programme; and conduct a process evaluation to examine service provider inputs and document service user perceptions of the programme.

Methods

Mixed quantitative, qualitative and process evaluation methods were used. Service providers were trained to use fourth generation rapid antibody/antigen HIV tests. Existing outreach services incorporated POCT into routine practice. Clients completed a semi-structured questionnaire and focus group discussions (FGDs) were held with service providers.

Results

Between September 2009 and June 2010, 953 individuals underwent POCT (GUM: 556 [59%]; community-based sites: 397 [42%]). Participants in the community were more likely to be male (p = 0.028), older (p < 0.001), of UK African origin (p < 0.001) and IDUs (p < 0.001) than participants from the GUM clinic. Seventeen new HIV diagnoses were confirmed (prevalence = 1.8%), 16 of whom were in risk exposure categories (prevalence: 16/517, 3.1%). Questionnaires and FGDs showed that clients and service providers were supportive of POCT, highlighting benefits of reaching out to marginalised communities and incorporating HIV prevention messages.

Conclusions

Community and GUM clinic-based POCT for HIV was feasible and acceptable to clients and service providers in a low prevalence setting. It successfully reached target groups, many of whom would not have otherwise tested. We recommend POCT be considered among strategies to increase the uptake of HIV testing among groups who are currently underserved.