title: Feasibility and acceptability of point of care HIV testing in community outreach and GUM drop-in services in the North West of England: a programmatic evaluation.
abstract: BACKGROUND
  In Liverpool, injecting drug users (IDUs), men-who-have-sex-with-men (MSM) and UK Africans experience a disproportionate burden of HIV, yet services do not reach out to these groups and late presentations continue. We set out to: increase testing uptake in targeted marginalized groups through a community and genitourinary medicine (GUM)-based point of care testing (POCT) programme; and conduct a process evaluation to examine service provider inputs and document service user perceptions of the programme.
  
  
  METHODS
  Mixed quantitative, qualitative and process evaluation methods were used. Service providers were trained to use fourth generation rapid antibody/antigen HIV tests. Existing outreach services incorporated POCT into routine practice. Clients completed a semi-structured questionnaire and focus group discussions (FGDs) were held with service providers.
  
  
  RESULTS
  Between September 2009 and June 2010, 953 individuals underwent POCT (GUM: 556 [59%]; community-based sites: 397 [42%]). Participants in the community were more likely to be male (p = 0.028), older (p < 0.001), of UK African origin (p < 0.001) and IDUs (p < 0.001) than participants from the GUM clinic. Seventeen new HIV diagnoses were confirmed (prevalence = 1.8%), 16 of whom were in risk exposure categories (prevalence: 16/517, 3.1%). Questionnaires and FGDs showed that clients and service providers were supportive of POCT, highlighting benefits of reaching out to marginalised communities and incorporating HIV prevention messages.
  
  
  CONCLUSIONS
  Community and GUM clinic-based POCT for HIV was feasible and acceptable to clients and service providers in a low prevalence setting. It successfully reached target groups, many of whom would not have otherwise tested. We recommend POCT be considered among strategies to increase the uptake of HIV testing among groups who are currently underserved.
authors.affiliation: Clinical Group, Liverpool School of Tropical Medicine, Pembroke Place, L3 5QA Liverpool, UK. p.macpherson@liv.ac.uk
authors.forename: Peter
authors.initials: P
authors.lastname: MacPherson
authors.forename: Anu
authors.initials: A
authors.lastname: Chawla
authors.forename: Kathy
authors.initials: K
authors.lastname: Jones
authors.forename: Emer
authors.initials: E
authors.lastname: Coffey
authors.forename: Vida
authors.initials: V
authors.lastname: Spaine
authors.forename: Ian
authors.initials: I
authors.lastname: Harrison
authors.forename: Pauline
authors.initials: P
authors.lastname: Jelliman
authors.forename: Penelope
authors.initials: P
authors.lastname: Phillips-Howard
authors.forename: Caryl
authors.initials: C
authors.lastname: Beynon
authors.forename: Miriam
authors.initials: M
authors.lastname: Taegtmeyer
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities; D003153:Community Health Services; D003159:Community-Institutional Relations; D004739:England; D005240:Feasibility Studies; D005260:Female; D017144:Focus Groups; D006679:HIV Seropositivity / Q000175:diagnosis*; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care; D019095:Point-of-Care Systems; D015397:Program Evaluation; D011795:Surveys and Questionnaires; D014566:Urogenital System; D055815:Young Adult