By Mark Gilbert
There are a lot of new test technologies in the pipeline: both new types of tests in the works, such as rapid syphilis tests or point-of-care HIV viral load testing, and new ways to use existing tests, such as self-testing or online testing.
As testing options increase, we need to think about where they will have the most impact. I learned about this from helping implement a new test technology called pooled nucleic acid amplification testing (pooled NAAT) at six clinics in Vancouver in 2009, as part of a research study to determine the impact of this new type of test on gay men’s lives. With pooled NAAT, blood samples that are negative on a routine screen for HIV antibodies are automatically tested for HIV RNA. This shortens the HIV window period to 10-12 days and means that individuals with very early or acute infection – when HIV viral load and chances of transmission are high – can be diagnosed at a time when standard tests are negative.
Here’s what I learned:
- Foster key partnerships: Introducing pooled NAAT was a joint effort of laboratory and public health staff, health care workers, community leaders and researchers. Identifying and including key partners early on was key.
- Target the test for the most impact: We targeted gay men given their high incidence rates and targeted clinics where gay men went for testing. It paid off: in the next three years, we saw twice the number of acute HIV diagnoses at these clinics (representing 60% of all acute HIV diagnoses in BC).
- Determine the advantage of the test and sell it: The test itself is not enough – people need to know about it! A new test technology will gain traction if it has an observable advantage over other tests. In the case of pooled NAAT, the advantage was the shorter window period and the ability to test sooner after a possible exposure or when starting a new relationship. It’s a complex concept and our community partner, the Health Initiative for Men, coined the phrase “the early test” as an understandable way to promote the test in the context of these everyday scenarios.
- Know that word gets around: Gay men are pretty savvy and engaged when it comes to new test technologies. In our research, some gay men said they first heard about the early test from their friends and sex partners, and having experienced it, many then spread the word as well.
- Educate before implementing. It took time at first for health care providers to understand how to interpret the results of pooled NAAT testing, so early education before implementation is important.
- Evaluate! Evaluation at all stages of implementing a new test technology is key to having the best impact. While research funding definitely helps, this can be as simple as seeking feedback from partners and potential users at key milestones.
Introducing a new test technology isn’t easy, but if taken up successfully, the pay-offs can be huge – leading to earlier diagnosis, faster treatment, and prevention of transmission. As a result of our research, targeted pooled NAAT testing continues to be offered in BC and individuals are being diagnosed with acute infections that would otherwise be missed. As for me, I regularly apply these lessons when thinking about implementing and evaluating new testing technologies – and will continue to do so, as more options appear in our testing toolkit.
Learn more about Mark’s research study by participating in CATIE’s webinar Implementing the “early” HIV test in Vancouver: from acute diagnosis to undetectable identity on March 1st at 1 pm EST.
Dr. Mark Gilbert is a community medicine specialist and the director of the Applied Epidemiology Unit at the Ontario HIV Treatment Network. He is an assistant professor at the Dalla Lana School of Public Health, at the University of Toronto.