title: The rapid test in Spanish pharmacies: a novel programme to reach heterosexual men?
abstract: OBJECTIVE
  Spain has been a pioneer in the implementation of rapid HIV testing programmes in pharmacies to increase access to testing. However, no formal evaluation of the effectiveness of these programmes has been carried out to date. Our aim was to evaluate the ability of a novel in-pharmacy rapid HIV testing programme to promote diagnosis and reach vulnerable populations.
  
  
  METHODS
  Between 2011 and 2012, 2168 people underwent testing in 16 urban pharmacies in 10 cities of a Spanish region with a low prevalence of HIV infection. The main outcomes of the programme were compared with those of the regional surveillance system for new HIV diagnoses (RHSS-CyL).
  
  
  RESULTS
  Overall, 52.8% of those tested were heterosexual men, 15.8% were men who have sex with men (MSM) and 25.3% were women. Nine per cent were immigrants and 41.9% were < 30 years old. In total, 59.5% of the heterosexual men, 44.6% of the MSM and 65.3% of the women were previously untested. There were 23 positive results, representing 6% of all new regional diagnoses in 2011. The global prevalence was 1.1% (95% confidence interval 0.6-1.5%) and the prevalence in MSM was 3.8%. Of the reactive results, 60.9% were in MSM, 34.8% in heterosexual men and only 4.3% in women, vs. 35.4%, 37.5% and 15.0%, respectively, reported by the RHSS-CyL. The mean age of those testing positive was 32.7 years vs. 38.7 years in the RHSS-CyL. Fifty per cent of MSM and 75% of heterosexual men testing positive were previously untested.
  
  
  CONCLUSIONS
  In Spain, this is the first programme not targeted at the most at-risk populations, and has been shown to be effective in reaching and diagnosing heterosexual men, who are the group most affected by delayed diagnoses. Heterosexual men accounted for over half of those tested and a third of those diagnosed, and most of them were previously untested. Young and previously untested MSM also greatly benefitted from the programme.
authors.affiliation: National Epidemiology Centre, Carlos III Health Institute, Madrid, Spain.|CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Fernández-Balbuena
authors.affiliation: Epidemiological Surveillance Service, Public Health Directorate, Regional Ministry of Health of Castilla and León, Valladolid, Spain.
authors.forename: H
authors.initials: H
authors.lastname: Marcos
authors.affiliation: Epidemiological Surveillance Service, Public Health Directorate, Regional Ministry of Health of Castilla and León, Valladolid, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Pérez-Rubio
authors.affiliation: National Epidemiology Centre, Carlos III Health Institute, Madrid, Spain.|CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Hoyos
authors.affiliation: CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.|National School of Health, Carlos III Health Institute, Madrid, Spain.
authors.forename: M J
authors.initials: MJ
authors.lastname: Belza
authors.affiliation: National Epidemiology Centre, Carlos III Health Institute, Madrid, Spain.|CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.
authors.forename: L
authors.initials: L
authors.lastname: de la Fuente
mesh_terms: D015492:AIDS Serodiagnosis / Q000379:methods*; D000328:Adult; D003157:Community Pharmacy Services; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology; D020010:Heterosexuality / Q000706:statistics & numerical data; D018451:Homosexuality, Male / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000458:organization & administration*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D015397:Program Evaluation; D013030:Spain / Q000453:epidemiology; D014505:Urban Population / Q000706:statistics & numerical data; D055815:Young Adult
keywords: HIV testing; community pharmacy; rapid HIV tests