Impact and experiences of offering HIV testing across a whole city population through primary care clusters and GP surgeries in the Texting 4 Testing (T4T) project

Problem

Widening access to HIV testing is considered to be an effective approach to meet the UK government’s goal of zero new HIV transmissions by 2030. In Cardiff and Vale (CAV), it is estimated that 2/1,000 residents are living with HIV and over 90% know their status. In 2021, a pilot offer to recommend online HIV self-sampling kits to all population covered by a cluster of GP surgeries in one area of CAV successfully diagnosed one individual with late asymptomatic HIV infection and was acceptable to healthcare workers and practice population. The question remained whether such interventions across a whole city would identify further undiagnosed cases and be acceptable to communities.

Approach

The Texting 4 Testing (T4T) project aimed to support GP surgeries across CAV to send an SMS text invite to order a HIV test through a national online postal testing service (https://www.friskywales.org/) to all practice patients aged 16+. All nine primary care clusters in the region were approached and where agreed, texts were sent from the practice. Click-throughs and subsequent test requests were logged with results collated. A survey of participating GP practices examined the impact on their services.

Findings

Six of the nine CAV primary care clusters had GP practices that sent text messages. From these, 20/41 practices sent 139,539 text messages to practice patients. There were 4,402 (3.2%) click throughs to the national online STI self-sampling service. In the eight weeks following text messages being sent, 418/2409 (17.4%) individuals ordering tests residing in a participating primary care cluster indicated that they had accessed the service after receiving a text message. Compared to those ordering a test who had not received a text message, those in receipt of a text message tended to be older, were more likely from a minority ethnic background, less likely to engage in oral sex, and 84.9% ordered a chlamydia/gonorrhoea test. Furthermore, compared to those ordering a test who had not received a text message, those receiving a text and ordering a test were less likely to return their test within 8 weeks (38.8% vs. 49.5%) and in those who returned a test positivity rates were lower (5.6% vs. 10.4%).

Consequences

Texting patients through GP surgeries is an acceptable strategy to deliver HIV testing at scale, was associated with a demographic shift in testers, and enabled testing for a wider range of STIs/BBVs beyond HIV. Lower positivity rates may imply that people are screening for STIs / BBVs rather than accessing the service due to symptoms. However, this approach may still have population-level benefits by raising awareness of the service and reducing onward transmission. Further work is needed to explore barriers towards returning test kits and how this service would work in different contexts.