Assessment of service refinement and its impact on repeat HIV testing by client's access to Australia's universal healthcare system: a retrospective cohort study.

Publisher: John Wiley & Sons, Inc Country of Publication: Switzerland NLM ID: 101478566 Publication Model: Print Cited Medium: Internet ISSN: 1758-2652 (Electronic) Linking ISSN: 17582652 NLM ISO Abbreviation: J Int AIDS Soc Subsets: MEDLINE

Publication: 2017- : Hoboken, NJ : John Wiley & Sons, Inc
Original Publication: [London] : BioMed Central

Universal Health Care*; AIDS Serodiagnosis/*statistics & numerical data ; HIV Infections/*diagnosis; Adolescent ; Adult ; Australia ; Female ; HIV Infections/prevention & control ; Health Risk Behaviors ; Health Services Accessibility ; Humans ; Male ; Mass Screening ; Retrospective Studies ; Sexual Behavior ; Unsafe Sex ; Young Adult

Introduction: Achieving the virtual elimination of HIV requires equitable access to HIV prevention tools for all priority populations. Restricted access to healthcare means migrants face particular barriers to HIV prevention services. In February 2016, a peer-led rapid HIV testing service for gay, bisexual and other men who have sex with men (gay and bisexual men, GBM) in Melbourne, Australia, introduced free sexually transmissible infection (STI) testing funded through Medicare (Australia's universal healthcare system). Medicare ineligible migrant clients were required to pay up to $158AUD for STI tests. We determined the uptake of STI testing and assessed the impact on repeat HIV testing among Medicare eligible and ineligible clients.
Methods: All HIV tests conducted between August 2014 and March 2018 were included. We describe client characteristics, STI testing uptake and HIV/STI positivity among Medicare eligible and ineligible clients. Repeat HIV testing, assessed as the percentage of HIV tests with a return test within six months, was compared pre-integration (August 2014-June 2016) and post-integration(July 2016-March 2018) of STI testing using segmented linear regression of monthly aggregate data for Medicare eligible and ineligible clients.
Results: Analyses included 9134 HIV tests among 4753 individuals. Medicare ineligible clients were younger (p < 0.01), and fewer reported previously testing for HIV (p < 0.01) and high HIV risk sexual behaviours. There was no difference in HIV positivity between the two groups (p = 0.09). STI testing uptake was significantly lower among Medicare ineligible clients (7.6%, 85.3%; p < 0.01). Following STI testing introduction there was an immediate increase in six-month return HIV testing (6.4%; p = 0.02) and a significantly increasing rate of return HIV testing between July 2016 and March 2018 (0.5% per month; p < 0.01) among Medicare eligible clients but no immediate change in return testing (-0.9%; p = 0.7) or the rate of change in return testing between July 2016 and March 2018 (0.1% per month; p = 0.3) among Medicare ineligible clients. In March 2018, six-month return HIV testing was 52.3% and 13.2% among Medicare eligible and ineligible clients respectively.
Discussion: Improvements in return HIV testing observed among Medicare eligible clients did not extend to Medicare ineligible clients highlighting the impact of inequitable access to comprehensive sexual healthcare on test-and-treat approaches to HIV prevention.
(© 2019 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society.)

BMC Health Serv Res. 2017 Oct 10;17(1):692. (PMID: 29017561)
J Virus Erad. 2017 Jul 1;3(3):168-184. (PMID: 28758027)
AIDS Behav. 2018 Jan;22(1):178-189. (PMID: 28849434)
J Int AIDS Soc. 2015 Aug 27;18:20221. (PMID: 26318960)
Sex Transm Dis. 2010 Apr;37(4):240-3. (PMID: 19959971)
BMC Infect Dis. 2018 Aug 20;18(1):410. (PMID: 30126355)
J Int AIDS Soc. 2018 Apr;21(4):e25104. (PMID: 29638044)
J Int AIDS Soc. 2019 Aug;22(8):e25353. (PMID: 31379067)
JMIR Res Protoc. 2018 Nov 20;7(11):e11028. (PMID: 30459142)
Front Public Health. 2018 May 29;6:151. (PMID: 29896468)
BMC Public Health. 2015 Dec 10;15:1228. (PMID: 26654427)
J Biomed Inform. 2009 Apr;42(2):377-81. (PMID: 18929686)
Eur J Public Health. 2013 Dec;23(6):1039-45. (PMID: 23002238)
J Acquir Immune Defic Syndr. 2015 Oct 1;70(2):204-11. (PMID: 26068723)
Sex Transm Infect. 2016 Sep;92(6):464-6. (PMID: 26801226)
Sex Health. 2016 Nov;13(6):560-567. (PMID: 27509318)
Sex Health. 2012 Nov;9(5):453-8. (PMID: 23380195)
Lancet HIV. 2018 Apr;5(4):e181-e189. (PMID: 29490875)

Keywords: MSM; HIV infections; community based; sexually transmitted diseases; testing; transients and migrants delivery of health care

Date Created: 20190806 Date Completed: 20200428 Latest Revision: 20231013

20240513

PMC6680090

10.1002/jia2.25353

31379067