In its earliest stages, HIV infection can be relatively silent – without testing for it, you wouldn't know for sure it is there. But if a person with HIV is treated early then the outcomes can be much better, according to Dr Gerard O'Connor, a specialist registrar in emergency medicine at the Mater Misericordiae University Hospital in Dublin.

He's project leader on the Mater-Bronx Rapid HIV Testing (M-BRiHT) project, a collaboration between UCD, the Mater and the Jacobi Medical Centre in New York, to encourage people to know their HIV status.

Since September of last year, more than 2,500 people attending the Mater’s Emergency Department have taken part, which means watching an interactive counselling video and completing an on-screen survey. And around three-quarters of participants have opted to take a rapid HIV test there and then.

"We found there's a 75 per cent acceptance rate for the HIV test, which is much higher than we thought we would get," says Dr O'Connor, a PhD research fellow with the HIV Molecular Research Group at University College Dublin and a lecturer in emergency medicine at UCD School of Medicine and Medical Science.

Rapid test
The test itself involves a quick swab inside the mouth, and within about 20 minutes one or more lines appear on it, much like a pregnancy test. It shows whether the body has been making antibodies to HIV, which would signal that there is an infection. The vast majority of tests come back negative, but some have been positive. When that happens, the person can immediately go under the care of the infectious diseases team at the Mater, led by Dr Paddy Mallon who heads the M-BRiHT project, and more tests are carried out to confirm the diagnosis.

“That immediate linkage with care is a crucial part of the process,” says Dr O’Connor. “Most people that we are diagnosing are at an early stage of HIV infection and still healthy, and getting the appropriate care at that early stage can make a big difference to outcome. Chances are they will have a near-normal life expectancy with appropriate care and they are less likely to find themselves in five or six years in hospital with an AIDS-defining illness or an opportunistic infection.”

Risk factors
The researchers are now looking at answers to the survey questions, some of which can ask directly about sexual and drug-related behaviours, notes Dr O'Connor. "People are pretty comfortable answering those, which is both surprising and reassuring," he says.

And the results are already pointing to some remarkable trends: of the 30 per cent of respondents who say they have had multiple sexual partners in the last year, less than one-fifth say they always use condoms, according to Dr O’Connor. “You need to be using condoms,” he says. “Anything other than always is a risk for those with multiple sexual partners. This message may have become diluted with the passage of time.”

And from the M-BRiHT survey data, the researchers can work out the potential infections averted by the diagnosis of HIV-positive participants, he explains. “Based on the risk factor data put into the survey we can robustly model the number of people that might have been infected in the coming five years if a person wasn’t diagnosed.”

The research project, which is sponsored through an unrestricted research grant from Gilead Sciences, has attracted interest from other centres, and O’Connor is now looking to get the system up and running in Manchester and in Modena, Italy.

And ultimately he hopes the Mater findings will prove that such a screening programme can work in an emergency department environment, and pave the way for becoming policy. “We want to be able to give policymakers the evidence that screening works in this setting,” he says.

The survey offers a new insight into HIV-related behaviours in in Ireland, according to Dr Mallon, an infectious diseases consultant at the Mater and head of the HIV Molecular Research Group at UCD. “It’s great to get so many people participating in the study, and I have never seen data like it before in an Irish context. It could drive a lot of policy change.”