New data showing a 3-fold increase in the annual number of gay and bisexual men (GBM) attending publicly funded HIV testing services and a reduction in undiagnosed cases of HIV in NSW since 2010 are being presented at the 2020 AIDS Virtual conference this week.
AIDS 2020 is the 23rd International AIDS Conference; a biannual conference coordinated by the International AIDS Society and the world’s largest conference on HIV/AIDS.
The analysis, led by the NSW HIV Prevention Partnership Project, pulls together state-wide data from 2010-2018, during which time HIV testing initiatives were increasingly targeted and optimised for GBM. The NSW Government developed two strategies to curb HIV transmission in the state: the first from 2012-15 and the second covering 2016-20.
"We measured HIV testing among gay and bisexual men in New South Wales, Australia between 2010 and 2018 to assess the impact of two statewide government HIV strategies that aimed to increase HIV testing,” says Phillip Keen, who co-led the study.
The NSW Government-led strategies prioritised increasing targeted HIV testing among GBM, who accounted for 80% of HIV diagnoses in NSW prior between 2010 and 2018. As part of this, ACON, which is the largest community-based HIV organisation in NSW, led a variety of campaigns using multiple platforms to promote HIV testing. There were also initiatives to increase the capacity of HIV testing services, such as express clinics at sexual health clinics, and innovations such as SMS appointment reminders were introduced. Additionally, new modes of HIV testing such as community-based, peer-led rapid HIV testing services and dried-blood spot home-sample collection for processing tests by mail were introduced.
Over the nine year lifespan of the study, the suite of initiatives led to significant increases in the total numbers of GBM attending clinics receiving an HIV test in a year, as well as an increase in HIV testing after diagnosis with a sexually transmitted infection. The number of men attending clinics more than tripled, and HIV testing in conjunction with diagnosis of a sexually transmitted infection increased by 37%.
“The frequency of annual HIV testing among high risk men in this population increased from 1.8 to 4.1 tests per year,” says Dr Prital Patel, who co-led the study. “We also found that the estimated proportion of undiagnosed HIV-positive men declined from 7.1% to 2.8% among Australian-born men, below the UNAIDS Fast Track target of 5% by 2030.”
While the overall figures were encouraging, the decrease in estimated undiagnosed HIV was not consistent across population groups. “It is concerning that the proportion of HIV-positive men who are undiagnosed rose among overseas-born men, from 15.3% to 16.9% from 2010 to 2018 respectively. This is six times higher than among Australian-born men," says Dr Patel.
Mr Keen says that more targeted promotion of HIV testing to overseas-born GBM, in a range of languages, would help see more consistent results across the state. “There is a need for targeted initiatives outside clinics to support overseas born gay and bisexual men to come forward for testing, or to access self-testing" he says.
“Across multiple testing indicators examined in this study, we have shown that testing uptake in overseas-born and Australian-born GBM has risen at similar rates and proportions at publically funded clinics. Connecting more overseas-born GBM to access routine care at these clinics could therefore help address the gaps in undiagnosed HIV,” says Dr Patel.
Mr Keen will be presenting this data as part of the AIDS2020 Virtual Conference, which is running online this week, 6-10 July 2020. The Conference will be run virtually, and delegates can view a range of pre-recorded and live sessions with HIV researchers from around the world.
There are a number of other Kirby Institute presentations at AIDS2020. A full list can be found below.
Live sessions
- Dr Jeff Jin, “A systematic review of HCV incidence among MSM: implications for HIV and viral hepatitis programming” as part of the session Time to move beyond HIV: Securing person-centred approaches to health with and for key populations, Live session Monday 6 July, 9-10pm PST.
- Professor Miles Davenport, Panel/Q&A discussion on: Tuesday 7 July at 11 pm PST, Thursday 9 July at 8 am PST.
- Dr Mohamed Hammoud, “Impact of physical distancing due to COVID-19 on HIV pre-exposure prophylaxis (PrEP) use and sexual behaviour among gay and bisexual men in Australia: Implications for trends in HIV,” oral presentation on Thursday, 9th July at 6pm AEST.
Pre-recorded presentations
- Dr Benjamin Bavinton, “What PrEP use means to people?” pre-recorded presentation as part of session Implementing people-centred PrEP.
- David Boettiger, “Statins for atherosclerotic cardiovascular disease prevention in people living with HIV in Thailand: a cost-effectiveness analysis" Pre-recorded presentation as part of session Launch of a JIAS Supplement: Integrating services for HIV and related comorbidities: modelling to inform policy and practice.
- Professor Miles Davenport, “The promise of Immunotherapy in HIV infection”, pre-recorded presentation as part of session Pushing the boundaries: New approaches to a cure.
- Professor Basil Donovan, “Debate: Should we use doxycycline post-exposure prophylaxis for STI prevention right now?” as part of session Synced up: STIs and HIV.
- Professor Andrew Grulich, “Elements of success in New South Wales”, pre-recorded presentation as part of the session How did they do it? What successful communities can teach all of us about making dramatic progress against HIV epidemics and what this means in the age of COVID.
- Professor Rebecca Guy, “New work on STI diagnostics and point-of-care testing”, pre-recorded presentation for session Synced up: STIs and HIV.
- Dr Bridget Haire, “The ethics of HIV prevention trials in 2020 and beyond”, pre-recorded presentation as part of the session Trials, tribulations and prevention.
- Dr Mohamed Hammoud, "Impact of social distancing due to COVID-19 on sexual behaviour among gay and bisexual men in Australia: Implications for trends in HIV and other sexually transmissible infections", Oral abstract OACLB0103.
- Mr Phillip Keen, “Increased targeted HIV testing and reduced undiagnosed HIV infections among gay and bisexual men in New South Wales, Australia 2010-2018”, pre-recorded presentation as part of session Can we achieve UTT? What can UTT achieve?
- Dr Nicholas Medland, “Successful National PrEP Scale-Up in Australia: Evaluation of uptake, consumption, adherence, retention and seroconversion”, pre-recorded presentation as part of the session PrEP at Scale.
- Dr Nicholas Medland, “The Price of Excluding Migrants from Biomedical HIV Prevention”, pre-recorded presentation as part of the session Borderless: HIV risks and service delivery for internally displaced people and global migrants.
E-posters
- Dr Alison Carter, "Beyond prevention: Recognizing the concerns about sexual wellbeing among women post HIV diagnosis", E-poster PED0873.
- Mr Patrick Eustaquio (CHART Program), "Key population-led, community-based test-and-treat approach to address the gaps in the HIV care cascade among men who have sex with men and transgender-women in the Philippines: A retrospective cohort analysis", E-poster PED1217.
- Dr Awachana Jiamsakul, "Trends in clinical follow-up between 2008-2018 among people living with HIV in the TREAT Asia and Australian HIV Observational Databases (TAHOD and AHOD)", E-poster PEB0091.
- Associate Professor Angela Kelly-Hanku, "High levels of HIV drug resistance and evidence of transmission clusters within and across key populations in Papua New Guinea: Results from a biobehavioural survey", E-poster PEC0500.
- Ms Vera Klemm, "Epigenetic silencing siRNA delivered to the nucleus of HIV-1 infected cells via nanoparticle system", E-poster PEA0062.
- Dr Amy Kwon, “Can we prevent COVID -19 epidemic in Prison setting: a modelling study”, poster presentation at the special COVID-19 Conference, following AIDS 2020 on 10-11 July 2020.
- Ms Lydia Nakiganda, "Health care seeking behaviours and challenges in accessing HIV services in men who have sex with men in rural Rakai, Uganda", E-poster PED0975.
- Ms Ye Zhang, "The "voice of women" to integrate HIV and syphilis testing in antenatal care: A systematic review of qualitative research", E-poster PEE1510.