AFAO NGMSAP Forum Recap Report

Screening and Testing in Clinical Settings Current clinical guidelines for HIV management and HIV & STI testing among gay men should be revised to ensure consistency with the NGMSAP. ‘ Red book’ authors should be approached to include sexual health checks Should include other tests for HIV-neg men e.g. rapid HIV and HIV antigen tests All public sexual health clinics and relevant private providers should review current syphilis testing services in order to reduce barriers to more frequent testing. Time (patient and provider) and space available Patients declining testing. Consent (and stigma) – reduce negative judging and valuing Complexity, co-morbidities and ageing. Priorities of HIV-pos men and HSA men cf. hep C Pester power and promotion of guidelines Need more data of patient experience and barriers e.g. waiting times and cost of appointment What about HIV-pos men not on ARV therapy – how to increase/maintain testing if not presenting for regular monitoring? Different approaches for GPs, hospital-based and sexual health clinics MSHC and E Syd Doctors opt out pathology form for HIV-pos men (it’s the frequency [that counts] stupid). Detects a much higher proportion of asymptomatic infections. Pop-up reminder for clinicians

Current clinical guidelines for HIV management and HIV & STI testing among gay men should be revised to ensure consistency with the NGMSAP.

‘ Red book’ authors should be approached to include sexual health checks

Should include other tests for HIV-neg men e.g. rapid HIV and HIV antigen tests

All public sexual health clinics and relevant private providers should review current syphilis testing services in order to reduce barriers to more frequent testing.

Time (patient and provider) and space available

Patients declining testing. Consent (and stigma) – reduce negative judging and valuing

Complexity, co-morbidities and ageing. Priorities of HIV-pos men and HSA men cf. hep C

Pester power and promotion of guidelines

Need more data of patient experience and barriers e.g. waiting times and cost of appointment

What about HIV-pos men not on ARV therapy – how to increase/maintain testing if not presenting for regular monitoring?

Different approaches for GPs, hospital-based and sexual health clinics

MSHC and E Syd Doctors opt out pathology form for HIV-pos men (it’s the frequency [that counts] stupid). Detects a much higher proportion of asymptomatic infections.

Pop-up reminder for clinicians

Screening and Testing in Clinical Settings Clinics review/develop procedures aimed at identifying highly sexually active HIV negative men (20+ 6/12) to ensure that they are tested in accordance with the recommendation. CASI self-assessment for HIV-neg men (incl. sms or email reminder) Standard sexual history taking software be developed MSM have regular contact with GPs but opportunistic testing requires skills, but ‘computer says yes’ options could be optimised Materials in waiting rooms Capacity building of low-caseload GPs

Clinics review/develop procedures aimed at identifying highly sexually active HIV negative men (20+ 6/12) to ensure that they are tested in accordance with the recommendation.

CASI self-assessment for HIV-neg men (incl. sms or email reminder)

Standard sexual history taking software be developed

MSM have regular contact with GPs but opportunistic testing requires skills, but ‘computer says yes’ options could be optimised

Materials in waiting rooms

Capacity building of low-caseload GPs

Screening and Testing in Clinical Settings Jurisdictions should review clinic hours and consider new service models. Research suggests that difficulty getting appt and unpredictable waiting times are major barriers out-of-hours and nurse-practitioner screening But out-of-hours services poorly attended (e.g. Saturday mornings at Holdsworth House, Sanctuary, and in BNE, but are successful in PER. Evening clinics vs. weekends?). But are these services promoted i.e. do potential new patients know about them? In PER took some time to build clientele Express clinic (Sydney SHSC) incl. self-collection and no-questions-asked

Jurisdictions should review clinic hours and consider new service models.

Research suggests that difficulty getting appt and unpredictable waiting times are major barriers

out-of-hours and nurse-practitioner screening

But out-of-hours services poorly attended (e.g. Saturday mornings at Holdsworth House, Sanctuary, and in BNE, but are successful in PER. Evening clinics vs. weekends?). But are these services promoted i.e. do potential new patients know about them? In PER took some time to build clientele

Express clinic (Sydney SHSC) incl. self-collection and no-questions-asked

Increasing Access to Screening and Testing Jurisdictions should review clinic hours and consider new service models. Partnerships with sexual health & pathology services with educators conducting pre- and post-test discussion (WA) Pre-signed pathology forms FLASH Clinic and Fast tracking (incl. pre-signed forms and swabs) Sauna-based testing – high test yield (WA) Venue-based testing can attract men not attending clinics, but would then be more likely to attend clinics in future (Qld)

Jurisdictions should review clinic hours and consider new service models.

Partnerships with sexual health & pathology services with educators conducting pre- and post-test discussion (WA)

Pre-signed pathology forms

FLASH Clinic and Fast tracking (incl. pre-signed forms and swabs)

Sauna-based testing – high test yield (WA)

Venue-based testing can attract men not attending clinics, but would then be more likely to attend clinics in future (Qld)

Increasing Access to Screening and Testing A working group should be established to trial or investigate use of rapid syphilis tests & develop guidelines for use of rapid tests. Hard to reach men should be a particular focus for increased testing initiatives. Acceptability study of rapid syph and HIV testing in MEL. (But rapid spyh test does not distinguish between current or previous infection – need algorithm for confirmatory testing) 70% said would increase testing frequency if offered in clinic 40% said would increase testing frequency if able to test at home Preferred rapid test because of immediacy, ease & simplicity, less pain , less invasive BUT some concerns How to integrate? Training & quality control? Medicare? What settings? Rapid test for syph is approved for use in Australia Need to get laboratories on board Home testing? (application with FDA for Orasure HIV home testing) Is there a population who are not currently testing at all who would test at home? (Similar concerns were raised about home pregnancy testing) Rapid testing is all the rage

A working group should be established to trial or investigate use of rapid syphilis tests & develop guidelines for use of rapid tests. Hard to reach men should be a particular focus for increased testing initiatives.

Acceptability study of rapid syph and HIV testing in MEL. (But rapid spyh test does not distinguish between current or previous infection – need algorithm for confirmatory testing)

70% said would increase testing frequency if offered in clinic

40% said would increase testing frequency if able to test at home

Preferred rapid test because of immediacy, ease & simplicity, less pain , less invasive BUT some concerns

How to integrate? Training & quality control? Medicare? What settings?

Rapid test for syph is approved for use in Australia

Need to get laboratories on board

Home testing? (application with FDA for Orasure HIV home testing) Is there a population who are not currently testing at all who would test at home? (Similar concerns were raised about home pregnancy testing)

Rapid testing is all the rage

Partner Notification Internet-based patient-led and/or clinician-led contact tracing systems should be incorporated into clinical practice. Incl. printable path forms (PER) & prescriptions (US and CAN) In DDU, two-thirds prefer sms reminders (for testing) [is this trend same for Let Him Know?] Limited evidence of hoax use Contact tracing profiles by public health agencies on gay sex sites (Wash DC model) Need better data on effectiveness – how many partners contacted and present for testing & treatment? Need more research on this. Not much published on effectiveness. Clinicians could get feedback on what happens i.e. need to see how data used. Also could be good education tool for low-caseload GPs. In Vic Enhanced Surveillance only 2 to3% tests were result of partner notification (based on clinicians perspective) Needs to be accompanied by protocol of what to do (New ASHM contract tracing guidelines out soon) High level of acceptability of contact tracing is evident in research – but historical concerns are still present among PLHIV

Internet-based patient-led and/or clinician-led contact tracing systems should be incorporated into clinical practice.

Incl. printable path forms (PER) & prescriptions (US and CAN)

In DDU, two-thirds prefer sms reminders (for testing) [is this trend same for Let Him Know?]

Limited evidence of hoax use

Contact tracing profiles by public health agencies on gay sex sites (Wash DC model)

Need better data on effectiveness – how many partners contacted and present for testing & treatment? Need more research on this. Not much published on effectiveness. Clinicians could get feedback on what happens i.e. need to see how data used. Also could be good education tool for low-caseload GPs.

In Vic Enhanced Surveillance only 2 to3% tests were result of partner notification (based on clinicians perspective)

Needs to be accompanied by protocol of what to do (New ASHM contract tracing guidelines out soon)

High level of acceptability of contact tracing is evident in research – but historical concerns are still present among PLHIV

Syphilis Awareness and Promoting Testing A nationally consistent approach to the marketing of information and key messages about syphilis to gay men should be developed. Motivated by own sexual health concerns (in ACON market testing) but additionally community motivation was identified in NCHECR market testing) Syph not high on agenda in terms of motivation for testing (cf. HIV) Perceived as dirty, shameful, ancient; associated with illicit behaviour ; unpleasant symptoms Baseline knowledge on transmission and symptoms is low Link testing to stopping spread of syph Avoid dirty and/or rusty imagery! Target, motivate, mobilise!

A nationally consistent approach to the marketing of information and key messages about syphilis to gay men should be developed.

Motivated by own sexual health concerns (in ACON market testing) but additionally community motivation was identified in NCHECR market testing)

Syph not high on agenda in terms of motivation for testing (cf. HIV)

Perceived as dirty, shameful, ancient; associated with illicit behaviour ; unpleasant symptoms

Baseline knowledge on transmission and symptoms is low

Link testing to stopping spread of syph

Avoid dirty and/or rusty imagery!

Target, motivate, mobilise!

Research 8) Australian funding sources for the syphilis chemoprophylaxis trial should be investigated if needed. Funding secured from US for study to start early 2010 but will need additional local funding esp for marketing etc.

8) Australian funding sources for the syphilis chemoprophylaxis trial should be investigated if needed.

Funding secured from US for study to start early 2010 but will need additional local funding esp for marketing etc.

Governance Jurisdictional committees (JC) should be should be established to oversee process at State and Territory levels. Yes, good idea A national committee should be established to monitor progress & convene annual NGMSAP review process. Yes, good idea

Jurisdictional committees (JC) should be should be established to oversee process at State and Territory levels.

Yes, good idea

A national committee should be established to monitor progress & convene annual NGMSAP review process.

Yes, good idea

Monitoring & Evaluation Committees responsible for syphilis surveillance, Periodic Surveys, and other relevant studies should review what enhancements can be undertaken to collect the NGMSAP indicators. National coordination i.e. consistent data collection (outputs, outcomes & impact) All jurisdictions should be able to collect data on MSM, symptoms and HIV status Contact tracing data collection is inconsistent Collect data on ‘contacts’ presenting for testing Consider sentinel surveillance of MSM in all jurisdictions (as in Victorian model) Need prevalence as well as notifications data Jurisdictional questionnaire – activities undertaken as part of the plan Sexual health service network (estd. for chlamydia) could be enhanced to include syphilis – can be used to determine syphilis prevalence among clinic attendees Consistent item on GCPS related to blood test for syphilis (from 2009 in Syd & Qld) Other enhancements to GCPS (but need consistency across country) Other studies e.g. HIV Futures, Private Lives and MYRIAD, and dedicated studies Need knowledge data Need urgent research on barriers to testing and on rapid testing (NCHSR & STIPU) Medicare data or laboratory network data Workforce development

Committees responsible for syphilis surveillance, Periodic Surveys, and other relevant studies should review what enhancements can be undertaken to collect the NGMSAP indicators.

National coordination i.e. consistent data collection (outputs, outcomes & impact)

All jurisdictions should be able to collect data on MSM, symptoms and HIV status

Contact tracing data collection is inconsistent

Collect data on ‘contacts’ presenting for testing

Consider sentinel surveillance of MSM in all jurisdictions (as in Victorian model)

Need prevalence as well as notifications data

Jurisdictional questionnaire – activities undertaken as part of the plan

Sexual health service network (estd. for chlamydia) could be enhanced to include syphilis – can be used to determine syphilis prevalence among clinic attendees

Consistent item on GCPS related to blood test for syphilis (from 2009 in Syd & Qld)

Other enhancements to GCPS (but need consistency across country)

Other studies e.g. HIV Futures, Private Lives and MYRIAD, and dedicated studies

Need knowledge data

Need urgent research on barriers to testing and on rapid testing (NCHSR & STIPU)

Medicare data or laboratory network data

Workforce development

Monitoring & Evaluation 14) A working group should be convened to operationalise the NGMSAP Monitoring and Evaluation Plan. Yes, good idea

14) A working group should be convened to operationalise the NGMSAP Monitoring and Evaluation Plan.

Yes, good idea