Increased HIV testing will modestly reduce HIV incidence among gay men in NSW and would be acceptable if HIV testing becomes convenient

Abstract

Objective: Determine 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.

Methods: We 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.

Results: If 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.

Conclusions: An 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.

Figure 1. Likelihood of testing more frequently among non HIV positive men.

(A) All non-positive respondents from online survey. (B) Non-positive men who engaged in UAIC. The data presented in the pie charts are available in Table S5 of the Supporting Information.

Figure 2. Mean change in HIV incidence and diagnoses due to increased testing.

Change for: (A) and (B) increased testing coverage; (C) and (D) testing of men who have not been tested previously; (E) and (F) increased testing frequency; and (G) and (H) synchronized or blitz testing.

Figure 3. Mean change in incidence and diagnoses if testing rates decrease.

Change in incidence (A) and diagnoses (B) if testing rates decrease by 30% and 50% relative to the current testing rate.