Community Testing: M Clinic Reflections


Published on

Michael Atkinson, (WA AIDS Council) describes development and progress of the only peer-based sexual health screening clinic in Australia: the M Clinic. This presentation was given at the AFAO/NAPWA Gay Men's HIV Health Promotion Conference in May 2012.

Published in: Health & Medicine
  • Be the first to comment

  • Be the first to like this

No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide
  • 8 medical suites – M Clinic discretely located down the back passage.
  • New clinic opens 5 June - Bigger and Better More space allows expanded peer education services (HIV peer education and SAMs) and counselling
  • 1. No surge capacity in existing sexual health services 1. National Syphilis Action Plan recommended to increase access to testing - Impetus for WAAC clinic followed by M Clinic – negotiated through WA STIGMA Committee3. Perth Gay Community Periodic Survey 4. Tertiary sexual health services have critically lowcapacity (3 FTE Sexual Health Physicians)- Long waiting periods for asymptomatic screening- Few gay friendly GPs and mostly closing their books 4. WAAC Sauna Clinic not enough5. Not WAAC or sauna 8. HIV and STI testing – appropriate call to action for engagement with broader health promotion strategies
  • 60 new clients per monthWe educate people about need for regular testing – majority of clients are regular testers People are willing to travel for accessible services Indicative of the return of testing culture??? (Social Marketing plays a key role in this) People are keen for ‘gay friendly services’ Feedback indicates gay men feel judged by immunology - people are electing to separate sexual health from HIV care
  • 11 since Nov 2011 – HIVSero-converters Study (Kirby Institute) Theoretically impacting downstream infections Particularly Rectal infections (chlamydia & gonorrhea) then syphilis 2 possibles5 arrived within the last 2 years – including 3 Asian2 x fisting (from a larger cohort), 1 x oral sex
  • Under 21 0 HIV yield (5.6% of testers) 21-30 years 52.9% of HIV yield (39.3% of testers)*31-40 years 11.8% of HIV yield (22.8% of testers)41-50 years 11.8% of HIV yield (17.8% of testers)51-60 years 23.5% of HIV yield (10.2% of testers)*61 + years 0 HIV yield (4.3% of testers)
  • There is a similar pattern with Syphilis as HIV: Under 30s and 51 – 60s are over-represented.
  • 3. Positive peer education, counselling and ongoing sexual health services4. From Medicare to State Health
  • Including AsymptomaticPeople who have taken risks We hope the data is rich enough to compare with non-M Clinic sero-converters
  • Community Testing: M Clinic Reflections

    1. 1. Community Testing M Clinic Reflections July 2010 – May 2012 Michael Atkinson
    2. 2. Overview1. Rationale for M Clinic2. What we have found3. Implications
    3. 3. Rationale for M Clinic1. Syphilis Outbreak mid 20062. At the same time - high level of asymptomatic STIs in WAAC Sauna Clinic3. PGCPS’s show: testing poor + Increasing UAIC4. General unmet supply of testing services5. Seen as a way to improve ‘testing culture’6. WAAC survey found guys wanted peer based service but more discrete7. Clinic provided a tangible hook to engage men in education
    4. 4. What have we found?
    5. 5. Clients1. 1310 clients since July 20102. >85% of clients have returned at least once3. Place of residence: 60% within 20km of CBD, 40% outer suburbs & state wide4. Majority hear about us though word of mouth5. Place of last test: Majority from GP, then tertiary sexual health service6. Increasing number of HIV positive clients
    6. 6. Clients by age600500400300 Age distribution200100 0 Under 21 21 - 30 31 - 40 41 - 50 51 - 60 61 + years years years years years years
    7. 7. HIV Diagnoses (22 months)• 18 HIV diagnoses• 14/18 incident cases• Over half had co-current STIs• All but 1 contracted in Australia• 9 Overseas born• UAI main mode of transmission
    8. 8. HIV Yield by Age 60 50 40 30 Testers % 20 HIV Yield % 10 0 Under 21 21 - 30 31 - 40 41 - 50 51 - 60 61 plus years years years years years yearsData provided by: Epidemiology and Surveillance Program, Communicable Disease ControlDirectorate, WA Department of Health
    9. 9. HIV & Syphilis Yield by Age60504030 Clients % HIV Yield %20 Infectious Syphilis Yield %10 0 Under 21 - 30 31 - 40 41 - 50 51 - 60 61 + 21 years years years years years yearsData provided by: Epidemiology and Surveillance Program, Communicable DiseaseControl Directorate, WA Department of Health
    10. 10. Interpretation1. The sexual health service gap in WA is experienced most by younger people (21-30 years) who require convenient, fast testing2. The older age bracket (51-60) may have decided that risky sexual practices are part of the deal as you get older.
    11. 11. WA HIV notifications – MSM 01 July 2011 to 31 March 2012Diagnosing Clinic Total Total%GPs 16 39%M Clinic 12 29%General sexual health clinics (n=3 clinics) 7 18%Hospital diagnoses (n=4 hospitals) 5 12%Private Infectious Diseases Consultant 1 2%Grand Total 41 100%
    12. 12. WA TrendsSince EstablishmentM Clinic has had the highest number of MSMHIV notifications from a single clinic in WASince November 2011M Clinic has diagnosed 50% of new HIVdiagnoses amongst gay men in WA
    13. 13. Compared with other settings in WA:M Clinic clients are:• More likely to have contracted HIV in Australia• More likely to have been tested because of risky behaviour• More likely to present for testing within one year of transmissionInformation provided by: Epidemiology and Surveillance Program,Communicable Disease Control Directorate, WA Department of Health
    14. 14. Implications• Positive response from the community • Potential to expand services to a condom-weary group • Potential to incorporate innovations such as Point of Care testing• Model attractive to under 30s • Potential to develop other strategies to engage this elusive target group• Large number of HIV diagnoses • Model provides opportunity for a holistic and integrated response at diagnosis – thus reducing long term impact • Potential to expand the range of services to HIV positive people• Shift towards community based screening in WA • Cost shifting
    15. 15. Implications cont…• The model facilitates early diagnoses of HIV & STIs • Potentially decreasing downstream infection • Complements ‘treatment as prevention’ model• M Clinic sees different clients to other clinics • People prefer to talk to a peer about risk behaviour • We are diagnosing people that may not have tested• Rich source of data - Research potential • Western Australian Sexual Health Services Survey – Kirby Institute • HIV Sero-converters Study (Recent HIV Spike) – Kirby Institute
    16. 16. Acknowledgements• Byron Minas, Lisa Bastian and the supportive team at CDCD, WA Department of Health• Mark Reid, Tony Bober, Garry Kuchel, Nadine Toussaint and all the peer educators at WAAC• Dr Lewis Marshall, Dr Paul Effler and the four other M Clinic doctors• The gay community and clients who have embraced and supported our clinic