The PRONTO! HIV RPOC Testing Model

The peer-delivered HIV RPOC testing model at PRONTO! has been described previously [31]. Briefly, PRONTO! provides free HIV RPOC testing (Trinity Biotech Uni-Gold HIV 1/2) according to manufacturer’s instructions [32]. The service operates on Saturday (10:30 am–2:30 pm) and weekday evenings (4:00–8:00 pm) and is staffed by one receptionist and two test facilitators. Almost all staff members identify as GBM and the service is advertised as being run by and for gay men. Peer testers do not necessarily have clinical qualifications but are trained in HIV pre- and post-test discussion and test device conduct.

Appointments are 30 min in duration, beginning with a self-completed behavioral questionnaire (described below) before consultation with a test facilitator for the HIV RPOC test. Following a discussion about the HIV testing device and possible results, a finger-prick blood specimen is collected and the HIV RPOC test started. During the 10-min test incubation time, the test facilitator engages clients in discussions about recent HIV/STI risk exposures, HIV risk reduction strategies and other information or referrals guided by clients’ needs.

All clients receiving non-reactive test results are encouraged to re-test quarterly. Following a reactive test result, venipuncture is performed for confirmatory laboratory-based serology and results provided one week later. Clients receiving a confirmed positive diagnosis are referred to specialist services of their choice for follow up care. If an HIV RPOC test result is invalid (neither non-reactive nor reactive) then it is repeated.

During the period of data collection, only HIV (and for a short period, syphilis) RPOC testing was offered at PRONTO!. Since February 2016, PRONTO! has integrated parallel HIV serology, full sexually transmissible infection (STI) screening (syphilis serology and throat swab, anal swab and first pass urine PCR for Chlamydia trachomatis and Neisseria gonorrhoeae), HIV pre-exposure prophylaxis (PrEP) initiation and maintenance and shares its premises with a trans and gender diverse health service.