A[TEST]: a case study from ACON
This case study demonstrates the theory of change working in practice. Through their engagement with their communities, alignment with the sector and their adaptation, ACON were able to achieve increased reach, increased effectiveness, increased efficiency, and stronger partnerships – all of which, led to better outcomes for their communities.
One of the most important public health interventions for reducing the transmission of HIV is increasing the rate of HIV testing among gay and bisexual men, and increasing how often these men get tested.1 In 2015, over one quarter of people diagnosed with HIV in 2015 had a late diagnosis, meaning that they were likely to have been living with HIV for at least four years before they were tested.2 Reducing late diagnoses is important because transmissions are most likely to occur when people are unaware of their status.3
Research has shown that traditional testing in clinical environments presents numerous barriers that prevent some gay and bisexual men getting tested as often as recommended. These barriers include stigma, fear of a positive result, the wait time for results and the inconvenience of testing.4
ACON (formally known as the AIDS Council of NSW) draws on its deep knowledge of the Lesbian, Gay, Bisexual, Trans, Intersex and Queer (LGBTIQ) community (engagement) to provide quality policy advice to government about the impact of the policy and legislative environment on testing rates (alignment). ACON have been at the forefront of efforts to increase access to new testing technologies in NSW, including advocating that the government play a proactive role in making rapid HIV testing available.
ACON has a strong reputation and credibility in the sector, enabling them to build strong partnerships between the community, clinicians and researchers. They played a lead role in the first community-based rapid HIV testing trial in NSW. In 2013, ACON, Sydney Sexual Health Centre and the Kirby Institute trialled the first community- based testing service. Following the success of this trial, ACON developed a partnership with NSW Ministry of Health, South East Sydney Local Health District, Sydney Sexual Health Centre and the NSW State Reference Laboratory to establish Sydney’s first peer-based HIV rapid-testing service: a[TEST] Oxford Street, which opened in 2015.
a[TEST] Oxford Street addresses many of the barriers to HIV testing (adaptation). A peer educator and a nurse work together to provide comprehensive sexual health screening. The peer educator walks the client through the process and addresses any concerns they have and then conducts the rapid HIV test (peer service delivery). While they are waiting for their results, the nurse takes blood for other STI tests and for a laboratory test to confirm the rapid HIV test results. The peer educator provides health promotion education and gives the client their results.
An evaluation of the service in June 2015 found exceptionally high satisfaction with the service with 100% of 221 evaluation participants indicating they would use the service again and 100% indicating they would recommend the service to others. One third of service users learned about the service from a friend, demonstrating that a high percentage of service users were recommending a[TEST] to their peers. These personal recommendations demonstrate that service users trust the service and are confident that their friend will have a positive experience.
The peer service delivery model is highly effective at reaching hard-to-reach and high-risk groups (reach), and this was supported by a strong promotional campaign that drew on ACON’s experience in social marketing and community engagement. Data from the service’s first year show that they are reaching men who have never been tested for HIV (12% of service users) and men who do not test as often as recommended (14% had not tested in the last 12 months). The service is also reaching men who are at relatively high risk of becoming infected with HIV: 31% had more than five partners in the previous three months and 43% had inconsistent condom use with casual partners. Between 2015 and 2016, 0.9% of those tested at a[TEST] Oxford Street were HIV positive, compared to 0.3% across other services in the same local health district. Therefore, a[TEST] Oxford Street provides an efficient service that is successfully reaching those most at risk of HIV.
Through understanding the needs of their communities, ACON have delivered an effective program that meets its goal of increasing the rate and frequency of HIV testing, particularly among men at high risk of becoming infected with HIV, making an important contribution to the goal of reducing HIV transmission.
- Wilson DP, Hoare A, Regan DG, Law MG. Importance of promoting HIV testing for preventing secondary transmissions: modelling the Australian HIV epidemic among men who have sex with men. Sex Health. Mar 2009;6(1):19-33.
- AFAO (2014) Discussion Paper: HIV testing among gay men and other men who have sex with men. Available from https://healthequitymatters.org.au/library/topic/msm/HIV_Testing_DP_ONLINE-July-2014.pdf
- Wilcock, B. & Frommer, M. (2014) ‘HIV testing among gay men and other men who have sex with men, AFAO Discussion Paper.
Case Study Theory of Change
HIV transmission are reduced