By Kristen Ochs
The State Government hopes new technology will help slash HIV transmission by 80 per cent. Rapid finger-prick and oral swab HIV tests are part of a NSW Health initiative, Ending HIV, which aims to halt the epidemic by 2020.
Up to 15,000 people are currently living with HIV in NSW. Only 70 per cent are aware they carry the virus, according to the Kirby Institute, a leading HIV research organisation at the University of New South Wales.
Alarm bells sounded in 2011 when, for the first time in 10 years, HIV notifications in NSW rose. The trend continued in 2012, prompting the Government to step in.
Increasing testing rates among gay men, who account for 80 per cent of HIV cases in NSW, forms the basis of the Government’s strategy.
Philip Cunningham, senior scientist at the HIV State Reference Laboratory, says, “If you identify people through testing, you can put them on treatment, then their viral load goes down and they become less infectious – you control the onward transmission.”
The Kirby Institute estimates the median time between being infected with HIV and actually being diagnosed is four years. Barriers to accessing testing account for much of the problem.
“Until recently, most places that offered testing required people to come back in a week to collect the result in person,” Phillip Keen, researcher at the Kirby Institute, says. “It’s hard to get appointments, you have to take time off work, it’s inconvenient.”
James Gray, Manager of Gay Men’s Sexual Health Programs at ACON (formerly the AIDS Council of NSW), says the week spent in limbo between having the blood test and getting the result causes significant anxiety.
Rapid HIV testing could be the solution, with finger-prick and oral swab devices giving results within 20 minutes.
ACON now offers rapid finger-prick testing at its Surry Hills and Newtown centres
as part of a research study funded by NSW Health. Peer educators, gay men trained to deliver the testing, provide pre-test counselling and ensure clients are referred to medical services if they test positive.
The new approach is working. Between 40 and 50 per cent of all clients coming in for a rapid test have either never been tested or have not tested for at least 12 months, according to Mr Gray.
But there are reasons why rapid testing is not yet widely available, with the two most commonly used devices still under review by the Therapeutic Goods Administration.
Philip Cunningham says people need to be aware that the sensitivity of rapid tests is much lower than standard blood tests.
“One of the key limitations is that the window period is much longer,” Mr Cunningham says.
Standard blood tests can pick up a positive result 10 to 15 days after a person is infected, but rapid tests will only detect the virus after three to four weeks. But Mr Cunningham says the public health argument for rapid testing is a valid counterpoint.
“The tests are not as good as conventional lab tests but they’re better than not having a test at all,” he says.
Self-testing at home is another weapon in the fight, overcoming the stigma that some men still feel around HIV testing.
“Some gay men don’t want to be seen at a clinic,” Phillip Keen says.
Currently, home testing remains within the boundaries of research studies, with the Kirby Institute enrolling men for its two year FORTH Study (Frequency of Oral HIV Testing at Home).
But self-testing could soon become mainstream, if the Commonwealth Government agrees to a recent recommendation from the National HIV Testing Policy Committee to scrap a law that currently prohibits home testing for infectious diseases.
In the United States, oral swab home test-kits are already sold over the counter in pharmacies.
Australian concerns around the accuracy of the oral swab test, which has a lower sensitivity than the finger-prick test, are an echo of the American debate a few years ago.
“When the US Food and Drug Administration approved the oral test, it announced that as high as one in 12 positives could be missed,” Philip Cunningham says.
However, public health experts felt that boosting testing rates outweighed the risks.
Dr Anthony Santella, sexual health researcher at the University of Sydney, believes home testing in Australia is inevitable.
“People are already doing it, they’re shipping them here from overseas,” he says. “If the Government wants any kind of control over it, it’s going to have to get involved.”
But the Ending HIV campaign is already having an impact. An extra 27,000 HIV tests were performed last year compared to the year before, according to Dr Daniel Maddedu, Deputy Director of the NSW Centre for Population Health.
While rapid testing is not perfect, it is opening the door for many who otherwise wouldn’t test.
“It’s not a silver bullet,” Philip Cunningham says, “but it’s another weapon in the armoury.”