Increased HIV Testing Will Modestly Reduce HIV Incidence among Gay Men in NSW and Would Be Acceptable if HIV Testing Becomes Convenient

Abstract

ObjectiveDetermine the acceptability and epidemiological impact of increases in HIV testing in gay men in New South Wales (NSW), Australia– particularly pertinent when considering treatment as prevention and the need to reduce undiagnosed infections.MethodsWe conducted an online survey and focus groups to assess whether increases in HIV testing would be acceptable to gay men in NSW. In parallel, we assessed the potential impact of increases in testing coverage and/or frequency using an individual-based model of HIV transmission.ResultsIf sexual practices and the rate of initiating HIV treatment are unchanged then increasing HIV testing reduces infections. Increasing testing frequency has the largest impact, with a 13.8% reduction in HIV infections over 10 years if the ∼55–75% of men who test at least once per year increased their testing frequency to four times per year. If testing levels decrease from current levels then we expect an increase in HIV infections with a sharply rising trend over time. Increasing HIV testing would be acceptable if testing was more convenient. However, only ∼25% of men surveyed were ‘very likely’ to increase their level of HIV testing. Men delayed or avoided testing due to the slowness in obtaining results and if they believed they had not put themselves at risk.ConclusionsAn increase in HIV testing alone is unlikely to reduce HIV incidence substantially in NSW gay men– however, the relatively high testing levels need to continue to prevent an increase in HIV infections. In jurisdictions with lower levels of HIV testing, increases in testing coverage and frequency are likely to have a larger impact. Successful treatment as prevention interventions will require increases in testing rates; such increases would be acceptable to gay men in NSW but only if more convenient testing and rapid communication of results were available.

Australian sexually transmissible infection and HIV testing guidelines for asymptomatic men who have sex with men 2014: a review of the evidence

“…If annual HIV testing coverage was increased to 100% of MSM, there would be a similar (11%) reduction in HIV infections over 10 years. Only one-third of Australian MSM in an online survey 150 reported being 'very likely' to increase their testing frequency from current levels, although men reporting recent unprotected anal intercourse and who were thus at the highest risk of HIV, were more willing to increase HIV testing frequency. Current inflexible and inconvenient clinic-based testing was cited as a barrier to achieving this goal.…”

“…150 Modelling indicated the single most effective scenario (increasing the frequency of testing among the 70-80% of MSM who already test annually to four times per year) resulted in a relatively modest 14% reduction in HIV incidence over 10 years, provided that other factors such as sexual behaviour and antiretroviral treatment initiation at a CD4 count of 350 cells mL -1 remain unchanged. If annual HIV testing coverage was increased to 100% of MSM, there would be a similar (11%) reduction in HIV infections over 10 years.…”

“…The availability of clinic-, community-or home-based rapid HIV testing may address some of these concerns, although there are few controlled studies on the impact of such strategies on the coverage or frequency of HIV testing. 151 Given that a large proportion of Australian MSM are not willing to test more frequently 150 and that many do not even have annual HIV testing, 142 testing for HIV at least once per year is recommended for all MSM. This recommendation is largely based on models suggesting little difference in the proportion of HIV infections averted between annual HIV testing among all MSM and current HIV testers being tested more often.…”

“…This recommendation is largely based on models suggesting little difference in the proportion of HIV infections averted between annual HIV testing among all MSM and current HIV testers being tested more often. 150 However, those at highest HIV risk, including those reporting unprotected anal intercourse, more partners, drug use during sex or group sex (Table 1), should be targeted for more frequent HIV testing. This subgroup of the men at highest risk also appear to be the most willing to increase their frequency of HIV testing.…”

2016 United Kingdom national guideline on the sexual health care of men who have sex with men

“…A further modelling study found that increasing testing from annually to 3-monthly in MSM is cost saving (224). An Australian modelling study suggested that increasing HIV testing in MSM from 1 to 4 times per year was estimated to have the potential to reduce HIV incidence in NSW by 13.8% over 10 years (225). Cost effectiveness analysis has been performed for syphilis testing in MSM living with HIV, suggesting 3 monthly screening is cost effective (226), but there is no comparable evidence with respect to other STIs in HIV negative MSM.…”