Importance of promoting HIV testing for preventing secondary transmissions: modelling the Australian HIV epidemic among men who have sex with men

Sexual Health ◽  
2009 ◽  
Vol 6 (1) ◽  
pp. 19 ◽  
Author(s):  
David P. Wilson ◽  
Alexander Hoare ◽  
David G. Regan ◽  
Matthew G. Law
Keyword(s):  
Hiv Testing ◽  
Early Treatment ◽  
Hiv Transmission ◽  
Public Health Intervention ◽  
Population Level ◽  
Hiv Infections ◽  
Long Term Effects ◽  
Wide Range ◽  
Epidemiological Impact ◽  
Sex With Men

Background: We address the research questions: (i) what proportion of new HIV infections is transmitted from people who are (a) undiagnosed, (b) in primary HIV infection (PHI), (c) on antiretroviral therapy?; and (ii) what is the expected epidemiological impact of (a) increasing the proportion of newly acquired HIV infections receiving early treatment, and (b) increasing HIV testing rates? Methods: We used a mathematical model to simulate HIV transmission in the population of men who have sex with men (MSM) in Australia. We calibrated the model using established biological and clinical data and a wide range of Australian MSM epidemiological and behavioural data sources. Results: We estimate that ~19% of all new HIV infections are transmitted from the ~3% of Australian HIV-infected MSM who are in PHI; ~31% of new HIV infections are estimated to be transmitted from the ~9% of MSM with undiagnosed HIV. We estimate that the average number of infections caused per HIV-infected MSM through the duration of PHI is ~0.14–0.28. Conclusions: The epidemiological impact of increasing treatment in PHI would be modest due to insufficient detection of newly-infected individuals. In contrast, increases in HIV testing rates could have substantial epidemiological consequences. The benefit of testing will also increase over time. Promoting increases in the coverage and frequency of testing for HIV could be a highly-effective public health intervention, but the population-level impact of interventions based on promoting early treatment of patients diagnosed in PHI is likely to be small. Treating PHI requires further evaluation of its long-term effects on HIV-infected individuals.

scholarly journals Antiretroviral therapy for prevention of HIV transmission: implications for Europe

2013 ◽  
Vol 18 (48) ◽  
Author(s):  
V Cambiano ◽  
J O’Connor ◽  
A N Phillips ◽  
A Rodger ◽  
R Lodwick ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
People Who Inject Drugs ◽  
Hiv Transmission ◽  
Controlled Trial ◽  
Population Level ◽  
Hiv Infections ◽  
Cd4 Count ◽  
Art Initiation ◽  
Sex With Men ◽  
Randomised Controlled

The aim of this review is to summarise the evidence on the population-level effect of antiretroviral therapy (ART) in preventing HIV infections, and to discuss potential implications in the European context of recommending starting ART when the CD4 count is above 350 cells/mm3. The ability of ART to reduce the risk of HIV transmission has been reported in observational studies and in a randomised controlled trial (HPTN 052), in which ART initiation reduced HIV transmission by 96% within serodiscordant couples. As yet, there is no direct evidence for such an effect among men having sex with men or people who inject drugs. HPTN 052 led international organisations to develop recommendations with a higher CD4 threshold for ART initiation. However, there remains a lack of strong evidence of clinical benefit for HIV-positive individuals starting ART with CD4 count above 350 cells/mm3. The main goal of ART provision should be to increase ART coverage for all those in need, based on the current guidelines, and the offer of ART to those who wish to reduce infectivity; increased HIV testing is therefore a key requirement. Other proven prevention means such as condom use and harm reduction for people who inject drugs remain critical.

Treatment for prevention of HIV transmission in a localised epidemic: the case for South Australia

Sexual Health ◽  
2011 ◽  
Vol 8 (3) ◽  
pp. 280 ◽  
Author(s):  
Kelly-Jean Heymer ◽  
David P. Wilson
Keyword(s):  
Hiv Transmission ◽  
South Australia ◽  
Hiv Infections ◽  
Small Population ◽  
Transmission Model ◽  
Minimal Impact ◽  
Gay Community ◽  
Epidemiological Impact ◽  
Sex With Men ◽  
Novel Model

Background Discussion is currently taking place among international HIV/AIDS groups around increasing HIV testing and initiating earlier use of antiretroviral therapy (ART) among people diagnosed with HIV as a method to reduce the spread of HIV. In this study, we explore the expected epidemiological impact of this strategy in a small population in which HIV transmission is predominantly confined to men who have sex with men (MSM). Methods: A deterministic mathematical transmission model was constructed to investigate the impacts of strategies that increase testing and treatment rates, and their likely potential to mitigate HIV epidemics among MSM. Our novel model distinguishes men in the population who are more easily accessible to prevention campaigns through engagement with the gay community from men who are not. This model is applied to the population of MSM in South Australia. Results: Our model-based findings suggest that increasing testing rates alone will have minimal impact on reducing the expected number of infections compared to current conditions. However, in combination with increases in treatment coverage, this strategy could lead to a 59–68% reduction in the number of HIV infections over the next 5 years. Targeting men who are socially engaged with the gay community would result in the majority of potential reductions in incidence, with only minor improvements possible by reaching all other MSM. Conclusions: Investing in strategies that will achieve higher coverage and earlier initiation of treatment to reduce infectiousness of HIV-infected individuals could be an effective strategy for reducing incidence in a population of MSM.

scholarly journals Sex-on-Premise Venues, Associated Risk Behaviors, and Attitudes toward Venue-Based HIV Testing among Men Who Have Sex with Men in Lima, Perú

2019 ◽  
Author(s):  
Alexander Lankowski ◽  
Hugo Sánchez ◽  
José Hidalgo ◽  
Robinson Cabello ◽  
Ann Duerr
Keyword(s):  
Hiv Testing ◽  
Sexual Risk ◽  
Risk Behaviors ◽  
Online Survey ◽  
Hiv Transmission ◽  
Sexual Risk Behaviors ◽  
Hiv Infections ◽  
Access To Treatment ◽  
Cross Sectional ◽  
Sex With Men

Abstract Background: In Perú, HIV disproportionately affects men who have sex with men (MSM). Despite widespread access to treatment, the rate of new HIV infections has not slowed over the last decade. Low knowledge of HIV status is a key factor underlying the high HIV incidence observed in this setting – creating conditions for efficient onward transmission in the population. Improving access to HIV testing and prevention services for those at highest risk is an important public health priority. Sex-on-premise venues (SOPVs) – saunas, sex clubs, pornographic movie theaters, hourly hotels, and bars/discos with areas where sex is permitted – may be opportune sites for outreach; however, further research on SOPVs and the populations who frequent them is needed to inform such efforts. Methods: We conducted a cross-sectional online survey of adult MSM in Lima, Perú to evaluate patterns of SOPV attendance, associated sexual risk behaviors, and attitudes toward SOPV-based interventions. Participants were recruited through outreach to social media networks affiliated with local LGBTQ-aligned community groups. Our primary analytic objective was to estimate the association of HIV-related sexual risk behaviors and SOPV attendance. Additionally, we performed exploratory analyses to describe risk behavior stratified by SOPV category and to examine the relationship between SOPV attendance and the use of online platforms to meet sex partners.Results: Overall, 389 MSM completed the survey from November 2018 through May 2019, of whom 68% reported attending an SOPV in the last three months. SOPV attendance was associated with multiple sexual risk behaviors, including transactional sex, group sex, sex while intoxicated, and higher number of total partners. Over two thirds of SOPV attendees indicated they would accept HIV testing if offered at SOPVs. Conclusions: SOPV attendance was common among MSM in Lima who participated in our survey, and SOPV attendees reported significantly greater engagement in sexual risk behaviors related to HIV transmission. Attitudes toward hypothetical SOPV-based interventions were generally favorable. These findings suggest that outreach at SOPVs may be an effective mechanism for reaching a particularly high-risk sub-population of MSM in Perú to deliver targeted HIV testing and prevention interventions.

'Getting to zero' in Asia and the Pacific through more strategic use of antiretrovirals for HIV prevention

Sexual Health ◽  
2014 ◽  
Vol 11 (2) ◽  
pp. 107 ◽  
Author(s):  
Michael M. Cassell ◽  
Timothy H. Holtz ◽  
Mitchell I. Wolfe ◽  
Michael Hahn ◽  
Dimitri Prybylski
Keyword(s):  
Hiv Prevention ◽  
Hiv Testing ◽  
Sex Workers ◽  
Population Level ◽  
Hiv Infections ◽  
Asia Pacific ◽  
Key Populations ◽  
Data Systems ◽  
Treatment Access ◽  
Sex With Men

Encouraged by experimental trials demonstrating the efficacy of antiretrovirals (ARVs) in preventing HIV infection, countries across the Asia-Pacific region have committed to the achievement of ambitious targets tantamount to ending AIDS. The available data suggest that some countries still can make progress through targeted condom promotion and the expansion of harm-reduction interventions, but that none may realise its vision of ‘zero new HIV infections’ without more strategic use of ARVs as part of a combination of HIV prevention efforts targeting key populations. Low rates of HIV testing among men who have sex with men, people who inject drugs, sex workers and other key populations evidence low treatment coverage where treatment could have the greatest impact on curbing local epidemics. Studies have demonstrated the promise of adding ARV treatment and pre-exposure prophylaxis to the existing HIV prevention toolkit, but achieving population-level impact will require service-delivery approaches that overcome traditional prevention, care and treatment program distinctions. Priorities include: (1) innovative strategies to reach, test, treat and retain in services the individuals most likely to acquire or transmit HIV; (2) task shifting and enhanced partnerships between the public sector and civil society; (3) improved ‘cascade’ data systems to assess and promote service uptake and retention; and (4) policy and financing reform to enhance HIV testing and treatment access among key populations.

scholarly journals Past dynamics of HIV transmission among men who have sex with men in Montreal, Canada: a mathematical modelling study

2021 ◽  
Author(s):  
Rachael M Milwid ◽  
Yiqing Xia ◽  
Carla Doyle ◽  
Joseph Cox ◽  
Gilles Lambert ◽  
...  
Keyword(s):  
Hiv Transmission ◽  
Age Groups ◽  
Population Level ◽  
Hiv Infections ◽  
Hiv Incidence ◽  
Agent Based ◽  
Treatment And Prevention ◽  
Sex With Men ◽  
Hiv Acquisition

Background: Gay, bisexual, and other men who have sex with men (gbMSM) experience disproportionate risks of HIV acquisition/transmission. In 2017, Montréal became the first Canadian Fast-Track city, setting the 2030 goal of zero new HIV infections. To inform local elimination efforts, we estimate the evolving role of prevention/risk behaviours and HIV transmission dynamics among gbMSM in Montréal between 1975-2019. Methods: Data from local bio-behavioural surveys were analyzed to develop, parameterize, and calibrate an agent-based model of sexual HIV transmission. Partnership dynamics, the HIV natural history, and treatment and prevention strategies were considered. The model simulations were analyzed to estimate the fraction of HIV acquisitions/transmissions attributable to specific age-groups and unmet prevention needs. Results: The model-estimated HIV incidence peaked in 1985 (2.2%; 90%CrI: 1.3-2.8%) and decreased to 0.1% (90%CrI: 0.04-0.3%) in 2019. Between 1990-2017, the majority of HIV acquisitions/transmissions occurred among men aged 25-44 years, and men aged 35-44 thereafter. The unmet prevention needs of men with >10 annual anal sex partners contributed 92-94% of transmissions and 63-73% of acquisitions annually. The primary stage of HIV played an increasing role over time, contributing to 12%-27% of annual transmissions over 1990-2019. In 2019, approximately 75% of transmission events occurred from men who had discontinued, or never initiated ART. Conclusions: The evolving HIV landscape has contributed to the recent low HIV incidence among MSM in Montréal. The shifting dynamics identified in this study highlight the need for continued population-level surveillance to identify unmet prevention needs and core groups on which to prioritize elimination efforts.

scholarly journals Implementation of a Rapid Entry Program Decreases Time to Viral Suppression Among Vulnerable Persons Living With HIV in the Southern United States

2018 ◽  
Vol 5 (6) ◽  
Author(s):  
Jonathan Colasanti ◽  
Jeri Sumitani ◽  
C Christina Mehta ◽  
Yiran Zhang ◽  
Minh Ly Nguyen ◽  
...  
Keyword(s):  
United States ◽  
Viral Suppression ◽  
Hiv Transmission ◽  
Positive Impact ◽  
Population Level ◽  
The United States ◽  
Clinic Visit ◽  
Art Initiation ◽  
Persons Living With Hiv ◽  
Sex With Men

Abstract Background Rapid entry programs (REPs) improve time to antiretroviral therapy (ART) initiation (TAI) and time to viral suppression (TVS). We assessed the feasibility and effectiveness of a REP in a large HIV clinic in Atlanta, Georgia, serving a predominately un- or underinsured population. Methods The Rapid Entry and ART in Clinic for HIV (REACH) program was implemented on May 16, 2016. We performed a retrospective cohort study with the main independent variable being period of enrollment: January 1, 2016, through May 15, 2016 (pre-REACH); May 16, 2016, through July 31, 2016 (post-REACH). Included individuals were HIV-infected and new to the clinic with detectable HIV-1 RNA. Six-month follow-up data were collected for each participant. Survival analyses were conducted for TVS. Logistic and linear regression analyses were used to evaluate secondary outcomes: attendance at first clinic visit, viral suppression, TAI, and time to first attended provider visit. Results There were 117 pre-REACH and 90 post-REACH individuals. Median age (interquartile range [IQR]) was 35 (25–45) years, 80% were male, 91% black, 60% men who have sex with men, 57% uninsured, and 44% active substance users. TVS decreased from 77 (62–96) to 57 (41–70) days (P < .0022). Time to first attended provider visit decreased from 17 to 5 days, and TAI from 21 to 7 days (P < .0001), each remaining significant in adjusted models. Conclusions This is the largest rapid entry cohort described in the United States and suggests that rapid entry is feasible and could have a positive impact on HIV transmission at the population level.

scholarly journals Evaluation of HIV Transmission Clusters among Natives and Foreigners Living in Italy

Viruses ◽  
2020 ◽  
Vol 12 (8) ◽  
pp. 791 ◽  
Author(s):  
Lavinia Fabeni ◽  
Maria Mercedes Santoro ◽  
Patrizia Lorenzini ◽  
Stefano Rusconi ◽  
Nicola Gianotti ◽  
...  
Keyword(s):  
Hiv Transmission ◽  
Phylogenetic Analyses ◽  
Hiv Infections ◽  
Public Health Response ◽  
Health Response ◽  
Drug Naïve ◽  
Recent Diagnosis ◽  
Sex With Men ◽  
Italian Origin ◽  
Hiv 1

We aimed at evaluating the characteristics of HIV-1 molecular transmission clusters (MTCs) among natives and migrants living in Italy, diagnosed between 1998 and 2018. Phylogenetic analyses were performed on HIV-1 polymerase (pol) sequences to characterise subtypes and identify MTCs, divided into small (SMTCs, 2–3 sequences), medium (MMTCs, 4–9 sequences) and large (LMTCs, ≥10 sequences). Among 3499 drug-naïve individuals enrolled in the Italian Cohort Naive Antiretroviral (ICONA) cohort (2804 natives; 695 migrants), 726 (20.8%; 644 natives, 82 migrants) were involved in 228 MTCs (6 LMTCs, 36 MMTCs, 186 SMTCs). Migrants contributed 14.4% to SMTCs, 7.6% to MMTCs and 7.1% to LMTCs, respectively. HIV-1 non-B subtypes were found in 51 MTCs; noteworthy was that non-B infections involved in MTCs were more commonly found in natives (n = 47) than in migrants (n = 4). Factors such as Italian origin, being men who have sex with men (MSM), younger age, more recent diagnosis and a higher CD4 count were significantly associated with MTCs. Our findings show that HIV-1 clustering transmission among newly diagnosed individuals living in Italy is prevalently driven by natives, mainly MSM, with a more recent diagnosis and frequently infected with HIV-1 non-B subtypes. These results can contribute to monitoring of the HIV epidemic and guiding the public health response to prevent new HIV infections.

scholarly journals Influence of serosorting and intervention-mediated changes in serosorting on the population-level HIV transmission impact of pre-exposure prophylaxis among men who have sex with men: a mathematical modelling study

2020 ◽  
Author(s):  
Linwei Wang ◽  
Nasheed Moqueet ◽  
Anna Simkin ◽  
Jesse Knight ◽  
Huiting Ma ◽  
...  
Keyword(s):  
Condom Use ◽  
Hiv Transmission ◽  
Population Level ◽  
Poor Adherence ◽  
Hiv Incidence ◽  
Individual Level ◽  
Prep Implementation ◽  
Mixing Patterns ◽  
Sex With Men ◽  
Exposure Prophylaxis

ABSTRACTBackgroundHIV pre-exposure prophylaxis (PrEP) may change serosorting patterns. We examined the influence of serosorting on the population-level HIV transmission impact of PrEP, and how impact could change if PrEP users stopped serosorting.MethodsWe developed a compartmental HIV transmission model parameterized with bio-behavioural and HIV surveillance data among men who have sex with men in Canada. We separately fit the model with serosorting and without serosorting (random partner-selection proportional to availability by HIV-status (sero-proportionate)), and reproduced stable HIV epidemics (2013-2018) with HIV-prevalence 10.3%-24.8%, undiagnosed fraction 4.9%-15.8%, and treatment coverage 82.5%-88.4%. We simulated PrEP-intervention reaching stable coverage by year-1 and compared absolute difference in relative HIV-incidence reduction 10-year post-intervention (PrEP-impact) between: models with serosorting vs. sero-proportionate mixing; and scenarios in which PrEP users stopped vs. continued serosorting. We examined sensitivity of results to PrEP-effectiveness (44%-99%) and coverage (10%-50%).FindingsModels with serosorting predicted a larger PrEP-impact compared with models with sero-proportionate mixing under all PrEP-effectiveness and coverage assumptions (median (inter-quartile-range): 8.1%(5.5%-11.6%)). PrEP users” stopping serosorting reduced PrEP-impact compared with when PrEP users continued serosorting: reductions in PrEP-impact were minimal (2.1%(1.4%-3.4%)) under high PrEP-effectiveness (86%-99%); however, could be considerable (10.9%(8.2%-14.1%)) under low PrEP effectiveness (44%) and high coverage (30%-50%).InterpretationModels assuming sero-proportionate mixing may underestimate population-level HIV-incidence reductions due to PrEP. PrEP-mediated changes in serosorting could lead to programmatically-important reductions in PrEP-impact under low PrEP-effectiveness (e.g. poor adherence/retention). Our findings suggest the need to monitor sexual mixing patterns to inform PrEP implementation and evaluation.FundingCanadian Institutes of Health ResearchRESEARCH IN CONTEXTEvidence before this studyWe searched PubMed for full-text journal articles published between Jan 1, 2010, and Dec 31, 2017, using the MeSH terms “pre-exposure prophylaxis (PrEP)” and “homosexuality, male” and using key words (“pre-exposure prophylaxis” or “preexposure prophylaxis” or “PrEP”) and (“men who have sex with men” or “MSM”) in titles and abstracts. Search results (520 records) were reviewed to identify publications which examined the population-level HIV transmission impact or population-level cost-effectiveness of PrEP in high-income settings. We identified a total of 18 modelling studies of PrEP impact among men who have sex with men (MSM) and four studies were based on the same model with minor variations (thus only the most recent one was included). Among the 15 unique models of PrEP impact, three included serosorting. A total of nine models have assessed the individual-level behaviour change among those on PrEP and its influence on the transmission impact of PrEP. Specifically, the models examined increases in number of partners and reductions in condom use. Most models predicted that realistic increases in partner number or decreases in condom use would not fully offset, but could weaken, PrEP”s impact on reducing HIV transmission. We did not identify any study that examined the influence of serosorting patterns on the estimated transmission impact of PrEP at the population-level, or what could happen to HIV incidence if the use of PrEP changes serosorting patterns.Added value of this studyWe used a mathematical model of HIV transmission to estimate the influence of serosorting and PrEP-mediated changes in serosorting on the transmission impact of PrEP at the population-level among MSM. We found the impact of PrEP was higher under epidemics with serosorting, compared with comparable epidemics simulated assuming sero-proportionate mixing. Under epidemics with serosorting, when PrEP users stopped serosorting (while other men continue to serosort among themselves) we found a reduced PrEP impact compared with scenarios when PrEP users continued to serosort. The magnitude of reduction in PrEP impact was minimal if PrEP-effectiveness was high; however, could be programmatically-meaningful in the context of low PrEP-effectiveness (e.g., poor adherence or retention) and high PrEP coverage. To our knowledge, our study is the first to directly examine the influence of serosorting and PrEP-mediated changes in serosorting on the transmission impact of PrEP and its underlying mechanism.Implications of all the available evidenceOur findings suggest that models which do not consider baseline patterns of serosorting among MSM could potentially underestimate PrEP impact. In addition to monitoring individual-level behavioural change such as condom use, our findings highlight the need to monitor population-level sexual mixing patterns and their changes over time among MSM in the design and evaluation of PrEP implementation.

scholarly journals Challenging the HIV Epidemic in Ontario Through PrEP and HIV Testing

2021 ◽  
Vol 2 (2) ◽  
Author(s):  
Steven Winkelman
Keyword(s):  
Hiv Testing ◽  
Hiv Infections ◽  
Hiv Treatment ◽  
Annotated Bibliography ◽  
Hiv Care ◽  
Post Exposure Prophylaxis ◽  
Non Profit ◽  
Sex With Men ◽  
Exposure Prophylaxis ◽  
Priority Populations

The Ontario HIV Treatment Network (OHTN) is a non-profit network which collaborates with health clinics, AIDS service and community organizations, and policy leaders in order to improve the health and wellbeing of people living with and at risk of HIV. I joined the OHTN as a member of the Collective Impact team, with a focus on examining the barriers and facilitators to Pre-Exposure Prophylaxis (PrEP) uptake in Ontario. PrEP is a once-daily pill which is highly effective in preventing HIV infections for HIV-negative people, however usage remains relatively low in Ontario. In this role, I liaised with the Knowledge Synthesis team at OHTN to collect, analyse, and synthesize recent scientific literature on Pre and Post-exposure prophylaxis (PEP) in order to create a comprehensive annotated bibliography on PrEP research. Key findings were drawn from the research to identify potential next steps to increase PrEP use for priority populations in Ontario. Findings from the annotated bibliography were presented to OHTN staff, and have been used to assist in the development of two PrEP study proposals; 1) a cisgender and transgender women-focused PrEP education package and HIV risk screening tool, and 2) a pharmacist-led PrEP delivery pilot. I also worked with the Testing and Clinical Initiatives team at the OHTN, to aid in the implementation and evaluation of two HIV-testing projects: the GetaTest pharmacy-based HIV-testing study, and the GetaKit HIV self-testing pilot program. In this role I drafted health communication materials; analysed survey data and drafted project reports for stakeholders; and provided perspectives on the HIV-care continuum, particularly on PrEP initiation, adherence, and efficacy. My work with the OHTN was important to public health because it sought to expand access to HIV testing and prevention services for priority populations in Ontario, including men who have sex with men, and cis and trans women.

scholarly journals Barriers to HIV Testing Among Young Men Who Have Sex With Men (MSM): Experiences from Clark County, Nevada

2015 ◽  
Vol 8 (7) ◽  
pp. 9 ◽  
Author(s):  
Jennifer R. Pharr ◽  
Nancy L. Lough ◽  
Echezona E. Ezeanolue
Keyword(s):  
Young People ◽  
Hiv Testing ◽  
Group Discussion ◽  
Hiv Infections ◽  
Young Person ◽  
Barriers And Facilitators ◽  
Clark County ◽  
Young Msm ◽  
Fear Of Rejection ◽  
Sex With Men

<p>Clark County, Nevada had a 52% increase in newly diagnosed HIV infections in young people age 13-24 with 83% of the new diagnoses in this age group being men who have sex with men (MSM). HIV testing and counseling is critical for HIV prevention, care and treatment, yet young people are the least likely to seek HIV testing. The purpose of this study was to identify barriers and facilitators to HIV testing experienced by young MSM in Clark County, Nevada.<strong> </strong>We conducted a qualitative focus group discussion to identify barriers and facilitators to HIV testing among eleven young MSM in March, 2015. The primary barrier to HIV testing identified by the group was a lack of awareness or knowledge about testing for HIV. Other barriers within the person included: fear of results, fear of rejection, and fear of disclosure. Barriers identified within the environment included: access issues, stigma, and unfriendly test environments for young people. In addition to increasing awareness, intervention to increase HIV testing among MSM young people should incorporate access to testing in environments where the adolescents are comfortable and which reduces stigma. HIV testing sites should be convenient, accessible and young person/gay friendly.</p>

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