Background
Method
The service
The evaluation
Sentinel surveillance and evaluation surveys
Recruitment and data collection
Data analysis
Focus group discussions
Recruitment and data collection
Data analysis
Ethics and consent
Results
Evaluation surveys
Sentinel surveillancea
| Survey one | Survey two | |||
---|---|---|---|---|---|
n (%) | n (%) |
p-valueb
| n (%) |
p-valuec
| |
1947 (100) | 118 (100) | 298 (100) | |||
Age | |||||
18–29 | 935 (48.0) | 55 (46.6) | 0.75 | 133 (44.6) | 0.37 |
30–39 | 613 (30.5) | 39 (33.1) | 0.75 | 94 (31.5) | 0.86 |
40+ | 399 (20.5) | 24 (20.3) | 0.98 | 71 (23.8) | 0.53 |
Median(IQR) | 30.45 (26–38) | 30 (26–36) | 31 (26–39) | ||
Country of birth | |||||
Australia | 1094 (58.1) | 79 (68.1) | 0.10 | 192 (66.0) | 0.06 |
Other | 789 (41.9) | 37 (31.9) | 0.25 | 99 (34.0) | 0.16 |
Residenced
| |||||
Metro Melbourne | 823 (93.7) | 110 (93.2) | 0.22 | 288 (96.6) | 0.56 |
Regional Victoria | 30 (3.4) | 2 (1.7) | 0.86 | 6 (2.0) | 0.80 |
Other/missing | 25 (2.9) | 6 (5.1) | 4 (1.3) | ||
High Riske
| |||||
No | 619 (31.8) | 31 (26.3) | 0.50 | 108 (36.2) | 0.40 |
Yes | 1328 (68.2) | 87 (73.7) | 0.26 | 190 (63.8) | 0.26 |
Service acceptability
Survey one n (%)a
118 (100.0) | Survey two n (%)a
298 (100.0) |
P-valueb
| |
---|---|---|---|
The opening hours are convenient for me | |||
Any agree | 111 (94.1) | 264 (88.6) | |
Not agree | 7 (5.9) | 34 (11.4) | 0.09 |
The location of PRONTO! is convenient for me | |||
Any agree | 94 (79.7) | 227 (76.4) | |
Not agree | 24 (20.3) | 70 (23.6) | 0.48 |
I found it easy to get an appointment at PRONTO! | |||
Any agree | 117 (99.2) | 287 (96.6) | |
Not agree | 1 (0.9) | 10 (3.4) | 0.15 |
I was comfortable waiting in the consultation room with the test facilitator | |||
Any agree | 111 (94.1) | 291 (97.7) | |
Not agree | 7 (5.9) | 7 (2.3) | 0.07 |
Overall, I prefer rapid testing to conventional HIV testing | |||
Any agree | 116 (98.3) | 261 (87.6) | |
Not agree | 2 (1.7) | 37 (12.4) | 0.001 |
I found our conversation useful in regards to my sexual health | |||
Any agree | 109 (92.4) | 250 (83.9) | |
Not agree | 9 (7.6) | 48 (16.1) | 0.02 |
They managed the whole experience professionally | |||
Any agree | 118 (100.0) | 293 (98.3) | |
Not agree | 0 (0.0) | 5 (1.7) | 0.16 |
Overall, I prefer testing with a peer test facilitator rather than a sexual health doctor or nurse | |||
Any agree | 92 (78.0) | 179 (60.3) | |
Not agree | 26 (22.0) | 119 (35.4) | 0.001 |
I am likely to return to PRONTO! for HIV testing | |||
Any agree | 113 (95.8) | 279 (93.9) | |
Not agree | 5 (4.2) | 18 (6.1) | 0.46 |
I am likely to test for HIV more frequently now that PRONTO! is open | |||
Any agree | 101 (85.6) | 254 (85.2) | |
Any disagree | 17 (14.4) | 44 (14.8) | 0.9 |
HIV and STI testing within the PRONTO! Model
Survey one n (%)f
118 (100) | Survey two n (%)f
298 (100) |
p-valueg
| |
---|---|---|---|
Ever tested for HIV | |||
No | 15 (13.3) | 48 (16.2) | |
Yes | 98 (86.7) | 248 (83.3) | 0.50 |
Typical HIV testing frequencya
| |||
Every 6 months or less | 66 (67.4) | 147 (59.5) | 0.28 |
Every 12 months | 25 (25.5) | 52 (21.1) | 0.66 |
Every 24 months or more | 7 (7.1) | 48 (19.4) | 0.43 |
Usual testing servicea
| |||
Sexual health centre | 47 (48.0) | 93 (37.8) | 0.28 |
High HIV caseload GP clinic | 19 (19.4) | 57 (23.2) | 0.75 |
Another GP | 20 (20.4) | 56 (22.8) | 0.84 |
Other | 8 (8.2) | 18 (7.3) | 0.75 |
No usual service | 4 (4.1) | 22 (8.9) | 0.98 |
Usually test for HIV and STIs at the same timea
| |||
No | 4 (4.4) | 25 (10.1) | 0.11 |
Yes | 87 (95.6) | 222 (89.9) | 0.72 |
Do you plan to seek STI testing following your most recent test at PRONTO! | |||
No | 28 (24.8) | 140 (47.8) | 0.03 |
Yes | 85 (75.2) | 153 (52.2) | < 0.01 |
Where do you plan to have this testb
| |||
Sexual health centre | 50 (58.1) | 61 (40.4) | 0.06 |
High HIV caseload clinic | 15 (17.4) | 50 (33.1) | 0.24 |
Another GP | 14 (16.3) | 32 (21.2) | 0.70 |
Other | 7 (8.1) | 8 (5.3) | 0.82 |
When do you plan to attend for this STI testb
| |||
In the next month | 47 (54.7) | 68 (45.0) | 0.31 |
In the next 3 months | 28 (32.6) | 58 (38.4) | 0.60 |
In the next 3-12 months | 10 (11.6) | 22 (14.6) | 0.83 |
In 12 months or more | 1 (1.2) | 3 (2.0) | – |
Since your first test at PRONTO! have you tested for HIV at a different clinicc
| |||
No | 215 (74.4) | ||
Yes | 74 (25.6) | ||
Where did you have this test c d
| |||
Sexual health centre | 23 (31.1) | ||
High HIV caseload clinic | 26 (35.1) | ||
Another GP | 17 (23.0) | ||
Other | 8 (10.8) | ||
Please indicate why c d e
| |||
I wanted to test for all STIs, including HIV | 52 (65.8) | ||
I had a doctor’s appointment for other reasons and I asked for or was offered an HIV test at the same time | 12 (16.0) | ||
I prefer to include conventional HIV tests as part of my testing routine | 9 (12.0) | ||
I received a reminder to test from my usual service | 4 (5.3) | ||
I had already booked an appointment for sexual health testing | 3 (4.0) | ||
I prefer testing at my usual HIV testing service | 1 (1.3) | ||
Since your first test at PRONTO!, have you tested for STIs other than HIV at a different clinicc
| |||
No | 208 (70.5) | ||
Yes | 87 (29.5) |
Focus group discussion
Testing environment
“I expected it to be like a doctors clinic, you walk in and get take a ticket, you’re told to sit on an uncomfortable chair, you sit there and wait for your name to be called out whereas like the guy was having a chat, gave me a clipboard, take a seat on the couch, help yourself to a drink, like, this is pretty cool” Paul, 28 years
Rapid testing process
While some participants reported having concerns about rapid test device accuracy and performance compared to conventional testing prior to attending PRONTO!, all agreed that their confidence in the technology improved following their experience at the service. Nevertheless, some participants reported that they would maintain occasional testing at clinical services because of the higher sensitivity of laboratory testing and peace of mind in accessing what they felt was more reliable laboratory-based HIV testing.“I’m generally not ever that worried about it (HIV), as I said it’s only when I’ve just got the test done that you start… the mind starts ticking, and the rapid test reduces that to 10 minutes and it means that I’m quite happy to go far more rather than if I had to wait a week every time” Evan, 25 years
“I guess I was reassured of, you know, I got to ask lots of questions about it and I felt reassured that it was just as effective as the standard test” Gabe, 25 years
Peer staff model
The value ascribed to the peer discussion was enhanced by the relationship that clients built with the peer staff. Participants described the improved test experience with a more relatable person conducting the test compared to participants’ previous experience with doctors and/or sexual health nurses. Some men discussed feeling at ease knowing that it was a peer testing them, and felt that peer testers broke down barriers that existed in standard clinical dialogue, enabling them to be more open in discussion about their sexual health.“the fact that you’ve got that wait time where you’re having a conversation with them waiting for the test results… you certainly don’t do that with a GP, a GPs mostly just sitting at their computer typing … but there was greater structured time for an actual conversation” Lawrence, 44 years
A number of participants weren’t aware that PRONTO! was a peer-led service when they first attended, and concerns were raised by some participants about confidentiality and potentially being tested by someone they knew. These concerns seemed to be allayed by the level of professionalism displayed by peer test facilitators. The professional conduct of the peer staff, balanced with the general relaxed style of the service, was important to participants feeling confident in the RPOC test result.“(the peer environment) lightens the mood, that’s for sure… that brings down barriers to discuss things that maybe bothering you or at the back of your mind” Vinay, 36 years
“I didn’t feel at all uncomfortable with them not being professionals and they did explain that they have received the training to do this test” Evan, 25 years
Convenience of the PRONTO! Model
“It made it less of a chore, like I never thought getting a test could be that easy, I just made an appointment half an hour before I was meeting my friends to go get burgers at Fitzroy, and I got it done and walked down Smith St and met them and had dinner” Ben, 20 years
Testing for HIV contrasted with testing for other STIs
Participants differed in their perceptions of their need to access STI testing in addition to HIV testing; these perceptions appeared to influence their decision to return to PRONTO! or test for HIV and STIs elsewhere. Some participants discussed their perceived need for HIV and STI testing in the context of a hierarchy of consequence, with a HIV diagnosis having the most severe consequence and conferring the greatest need for testing. Participants making testing decisions on this basis would delay asymptomatic STI testing at other clinical services in preference for more convenient HIV testing at PRONTO!.“Just because I don’t want to go to two places, I would probably just go to my one place and get everything done in one sitting” Hugo, 21 years
Other participants discussed their decision to test for HIV and STIs in the context of a hierarchy of perceived risk of infection. These participants generally spoke about the higher likelihood of acquiring an STI other than HIV resulting in a preference for comprehensive HIV and STI screening.“HIV’s the big concern, but anything else there’s either symptoms or… depending on what’s going on, if you think you’ve had any exposure to anything, so that (no STI testing) wouldn’t affect my using the service” Ulric, 26 years
“I probably won’t use PRONTO!, for me, I’ll just go back to the (sexual health clinic) ‘cause, you know, HIV is just one test… it’s not something that bugs me, it’s the others that bug me more” Vinay, 36 years