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Introduction: Outbreaks of hepatitis C virus (HCV) infections among HIV-positive men who have sex with men (MSM) have been observed globally. Using a multi-modelling approach we estimate the time and number of direct-acting antiviral treatment courses required to achieve an 80% reduction in HCV prevalence among HIV-positive MSM in the state of Victoria, Australia., Methods: Three models of HCV transmission, testing and treatment among MSM were compared: a dynamic compartmental model; an agent-based model (ABM) parametrized to local surveillance and behavioural data ("ABM1"); and an ABM with a more heterogeneous population ("ABM2") to determine the influence of extreme variations in sexual risk behaviour., Results: Among approximately 5000 diagnosed HIV-positive MSM in Victoria, 10% are co-infected with HCV. ABM1 estimated that an 80% reduction in HCV prevalence could be achieved in 122 (inter-quartile range (IQR) 112 to 133) weeks with 523 (IQR 479 to 553) treatments if the average time from HCV diagnosis to treatment was six months. This was reduced to 77 (IQR 69 to 81) weeks if the average time between HCV diagnosis and treatment commencement was decreased to 16 weeks. Estimates were consistent across modelling approaches; however ABM2 produced fewer incident HCV cases, suggesting that treatment-as-prevention may be more effective in behaviourally heterogeneous populations., Conclusions: Major reductions in HCV prevalence can be achieved among HIV-positive MSM within two years through routine HCV monitoring and prompt treatment as a part of HIV care. Compartmental models constructed with limited behavioural data are likely to produce conservative estimates compared to models of the same setting with more complex parametrizations., (© 2018 The Authors. Journal of the International AIDS Society published by John Wiley & sons Ltd on behalf of the International AIDS Society.)

Introduction: Exploration of sexual and drug use behaviours following treatment for recent hepatitis C virus (HCV) is limited. This analysis modelled behavioural trajectories following treatment for recent HCV and assessed reinfection. Methods: Participants treated for recent HCV in an international trial (enrolled 2017–2019) were followed at 3‐monthly intervals for up to 2 years to assess longitudinal behaviours. Population‐averaged changes were assessed using generalized estimating equations. Distinct behavioural trajectories were identified using group‐based trajectory modelling. HCV reinfection incidence was calculated using person‐years (PY) of observation. Results: During the follow‐up of 212 participants (84% gay and bisexual men [GBM]; 69% HIV; 26% current injecting drug use [IDU]), behavioural trajectories for IDU and stimulant use (past month) did not change. However, population‐averaged decreases in the likelihood of daily IDU (adjusted odds ratio [AOR] 0.83; 95% CI 0.72, 0.95) and opioid use (AOR 0.84; 95% CI 0.75, 0.93) were observed. Among GBM, behavioural trajectories for chemsex did not change. Population‐averaged decreases in condomless anal intercourse with casual male partners (CAI‐CMP) (AOR 0.95; 95% CI 0.90, 0.99) and group‐sex (AOR 0.86; 95% CI 0.80, 0.93) were observed, but masked distinct trajectories. While a proportion had a decreased probability of CAI‐CMP (23%) and group‐sex (59%) post‐treatment, a substantial proportion retained a high probability of these behaviours. High HCV reinfection incidence was observed for the sustained high probability IDU (33.0/100 PY; 95% CI 17.7, 61.3) and chemsex (23.3/100 PY; 95% CI 14.5, 37.5) trajectories. Conclusions: Limited sexual and drug use behavioural change was observed following treatment for recent HCV, supporting access to surveillance and (re)treatment. [ABSTRACT FROM AUTHOR]

OAA0304 Hypoxic adaptation uncovers a glycolytic dependence of HIV-1 latency reversal Y.I. Kayode SP 1 sp , D.C. Clemmer SP 1 sp , A.A. Owolabi SP 1 sp , L.M. Clark SP 1 sp , H.E. Taylor SP 1 sp SP 1 sp SUNY Upstate Medical University, Microbiology and Immunology, Syracuse, United States B Background b : The main barrier to HIV-1 curative strategies is the persistence of latently infected CD4 T cells in lymphoid tissue compartments which readily fuel viral rebound following antiretroviral therapy (ART) interruption in people living with HIV (PLWH). Mamba SP 1 sp , V. Williams SP 1 sp , A. Mafukidze SP 1 sp , P. Bongomin SP 1 sp , P. Dlamini SP 1 sp , G. Mchunu SP 1 sp , S. Mhlanga SP 1 sp , H. Byarugaba SP 1 sp , J. Opoku SP 2 sp , S. Kibwana SP 3 sp , S. Ojoo SP 2 sp , D. Bazira SP 2 sp , S. Haumba SP 1 sp SP 1 sp Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini, SP 2 sp Center for Global Health Practice and Impact, Georgetown University Medical Center, Washington DC, United States, SP 3 sp Center for Global Health Practice and Impact, Georgetown University Medical Center, Washington, United States B Background b : Pill count is widely used as an adherence measure among clients taking antiretroviral therapy (ART). OAA0102 Resident microbiota enhance HIV acquisition, replication and pathogenesis in vivo A. Wahl SP 1 sp , W. Yao SP 1 sp , B. Liao SP 1 sp , M. Chateau SP 1 sp , C. Richardson SP 1 sp , L. Ling SP 1 sp , J. Tucker SP 1 sp , I. McGowan SP 2 sp , R.B. Sartor SP 1 sp , J.V. Garcia SP 1 sp SP 1 sp University of North Carolina at Chapel Hill, Chapel Hill, United States, SP 2 sp University of Pittsburgh Medical School, Pittsburgh, United States B Background b : Resident microbiota maintain intestinal homeostasis by regulating digestion, metabolism, immune development and providing protection from infection. [Extracted from the article]

Introduction: Of 37.7 million people living with HIV in 2020, 6.1 million still do not know their HIV status. We synthesize evidence on concurrent HIV testing among people who tested for other sexually transmitted infections (STIs). Methods: We conducted a systematic review using five databases, HIV conferences and clinical trial registries. We included publications between 2010 and May 2021 that reported primary data on concurrent HIV/STI testing. We conducted a random‐effects meta‐analysis and meta‐regression of the pooled proportion for concurrent HIV/STI testing. Results: We identified 96 eligible studies. Among those, 49 studies had relevant data for a meta‐analysis. The remaining studies provided data on the acceptability, feasibility, barriers, facilitators, economic evaluation and social harms of concurrent HIV/STI testing. The pooled proportion of people tested for HIV among those attending an STI service (n = 18 studies) was 71.0% (95% confidence intervals: 61.0–80.1, I2 = 99.9%), people tested for HIV among those who were tested for STIs (n = 15) was 61.3% (53.9–68.4, I2 = 99.9%), people tested for HIV among those who were diagnosed with an STI (n = 13) was 35.3% (27.1–43.9, I2 = 99.9%) and people tested for HIV among those presenting with STI symptoms (n = 3) was 27.1% (20.5–34.3, I2 = 92.0%). The meta‐regression analysis found that heterogeneity was driven mainly by identity as a sexual and gender minority, the latest year of study, country‐income level and region of the world. Discussion: This review found poor concurrent HIV/STI testing among those already diagnosed with an STI (35.3%) or who had symptoms with STIs (27.1%). Additionally, concurrent HIV/STI testing among those tested for STIs varied significantly according to the testing location, country income level and region of the world. A few potential reasons for these observations include differences in national STI‐related policies, lack of standard operation procedures, clinician‐level factors, poor awareness and adherence to HIV indicator condition‐guided HIV testing and stigma associated with HIV compared to other curable STIs. Conclusions: Not testing for HIV among people using STI services presents a significant missed opportunity, particularly among those diagnosed with an STI. Stronger integration of HIV and STI services is urgently needed to improve prevention, early diagnosis and linkage to care services. [ABSTRACT FROM AUTHOR]

Introduction: Studies suggest that hepatitis C virus (HCV) micro‐elimination is feasible among men who have sex with men (MSM) living with human immunodeficiency virus (HIV), through treatment‐as‐prevention and interventions aimed at reducing risk behaviours. However, their economic impact is poorly understood. The aim of this study was to assess the cost‐effectiveness of HCV screening and risk reduction strategies in France. Methods: A compartmental deterministic mathematical model was developed to describe HCV disease transmission and progression among MSM living with HIV in France. We evaluated different combinations of HCV screening frequency (every 12, 6 or 3 months) and risk reduction strategies (targeting only high‐risk or all MSM) from 2021 onwards. The model simulated the number of HCV infections, life‐expectancy (LYs), quality‐adjusted life‐expectancy (QALYs), lifetime costs and incremental cost‐effectiveness ratio (ICER) over a lifetime horizon (leading to an end of the simulation in 2065). Results: All strategies increased QALYs, compared with current practices, that is yearly HCV screening, with no risk reduction. A behavioural intervention resulting in a 20% risk reduction in the high‐risk group, together with yearly screening, was the least expensive strategy, and, therefore, cost‐saving compared to current practices. The ICER per QALY gained for the strategy combining risk reduction for the high‐risk group with 6‐month HCV screening, compared to risk reduction with yearly screening, was €61,389. It also prevented 398 new HCV infections between 2021 and 2065, with a cost per infection averted of €37,790. All other strategies were dominated (more expensive and less effective than some other available alternative) or not cost‐effective (ICER per QALY gained > €100,000). Conclusions: In the French context, current HCV screening practices without risk reduction among MSM living with HIV cannot be justified on economic grounds. Risk reduction interventions targeted to high‐risk individuals—alongside screening either once or twice a year—could be cost‐effective depending on the policymaker's willingness‐to‐pay. [ABSTRACT FROM AUTHOR]

Evaluation of the kinetics of systemic distribution of IV injected monoclonal antibodies modi... B A.M. Carias SP 1 sp , J. Schneider SP 2 sp , M. McRaven SP 1 sp , S. Xiao SP 1 sp , K. Rogers SP 3 sp , M. Araínga SP 3 sp , R. Veazey SP 4 sp , F. Villinger SP 3 sp , T.J Hope SP 1 sp b SP 1 sp Northwestern University, Cell and Developmental Biology, Evanston, United States, SP 2 sp Rush University, United States, SP 3 sp New Iberia Research Center, United States, SP 4 sp Tulane National Primate Research Center, United States B Background: b Antibody-mediated protection against HIV/SHIV transmission has been illustrated in non-human primates (NHP) with IV injection of broadly neutralizing monoclonal antibodies (bNAbs). Understanding the mechanisms behind why IgA inhibits Fc responses could lead to improved future HIV vaccine design and educate passive transfer monoclonal antibody therapies. B Results: b 18,172 surveyed adults were categorized into one of six HIV risk types, each showing a unique pattern of five risk factors that conveyed HIV transmission and/or acquisition risk propensity. [Extracted from the article]

Introduction: The human immunodeficiency virus 1 (HIV‐1) pandemic is characterized by numerous distinct sub‐epidemics (clusters) that continually fuel local transmission. The aims of this study were to identify active growing clusters, to understand which factors most influence the transmission dynamics, how these vary between different subtypes and how this information might contribute to effective public health responses. Methods: We used HIV‐1 genomic sequence data linked to demographic factors that accounted for approximately 70% of all new HIV‐1 notifications in New South Wales (NSW). We assessed differences in transmission cluster dynamics between subtype B and circulating recombinant form 01_AE (CRF01_AE). Separate phylogenetic trees were estimated using 2919 subtype B and 473 CRF01_AE sequences sampled between 2004 and 2018 in combination with global sequence data and NSW‐specific clades were classified as clusters, pairs or singletons. Significant differences in demographics between subtypes were assessed with Chi‐Square statistics. Results: We identified 104 subtype B and 11 CRF01_AE growing clusters containing a maximum of 29 and 11 sequences for subtype B and CRF01_AE respectively. We observed a > 2‐fold increase in the number of NSW‐specific CRF01_AE clades over time. Subtype B clusters were associated with individuals reporting men who have sex with men (MSM) as their transmission risk factor, being born in Australia, and being diagnosed during the early stage of infection (p < 0.01). CRF01_AE infections clusters were associated with infections among individuals diagnosed during the early stage of infection (p < 0.05) and CRF01_AE singletons were more likely to be from infections among individuals reporting heterosexual transmission (p < 0.05). We found six subtype B clusters with an above‐average growth rate (>1.5 sequences / 6‐months) and which consisted of a majority of infections among MSM. We also found four active growing CRF01_AE clusters containing only infections among MSM. Finally, we found 47 subtype B and seven CRF01_AE clusters that contained a large gap in time (>1 year) between infections and may be indicative of intermediate transmissions via undiagnosed individuals. Conclusions: The large number of active and growing clusters among MSM are the driving force of the ongoing epidemic in NSW for subtype B and CRF01_AE. [ABSTRACT FROM AUTHOR]

Introduction: Young men who have sex with men (MSM) and transgender women (TGW) face stigmas that hinder access to healthcare. The aim of the study was to understand age‐related determinants of healthcare needs and engagement among MSM and TGW. Methods: The TRUST/RV368 cohort provides integrated prevention and treatment services for HIV and other sexually transmitted infections (STIs) tailored to the needs of sexual and gender minorities. MSM and TGW aged ≥16 years in Abuja and ≥18 years Lagos, Nigeria, completed standardized behavioural questionnaires and were tested for HIV, Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) every three months for up to 18 months. Logistic regression was used to estimate adjusted odds ratios (aORs) for associations of age and other factors with outcomes of interest upon enrolment, including HIV care continuum steps – HIV testing, ART initiation and viral suppression <1000 copies/mL. Cox proportional hazards models were used to calculate adjusted hazard ratios (aHRs) for associations with incident infections. Results: Between March 2013 and February 2019, 2123 participants were enrolled with median age 23 (interquartile range 21 to 27) years. Of 1745 tested, 865 (49.6%) were living with HIV. HIV incidence was 11.6/100 person‐years [PY], including 23.1/100PY (95% CI 15.5 to 33.1) among participants aged 16 to 19 years and 23.8/100 PY (95% CI 13.6 to 39.1) among TGW. Compared to participants aged ≥25 years, those aged 16 to 19 years had decreased odds of prior HIV testing (aOR 0.40 [95% CI 0.11 to 0.92]), disclosing same‐sex sexual practices to healthcare workers (aOR 0.53 [95% CI 0.36 to 0.77]) and receiving HIV prevention information (aOR 0.60 [95% CI 0.41 to 0.87]). They had increased odds of avoiding healthcare (aOR 1.94 [95% CI 1.3 to 2.83]) and engaging in transactional sex (aOR 2.76 [95% CI 1.92 to 3.71]). Age 16 to 19 years was independently associated with increased incidence of HIV (aHR 4.09 [95% CI 2.33 to 7.49]), NG (aHR 3.91 [95% CI 1.90 to 8.11]) and CT (aHR 2.74 [95% CI 1.48 to 5.81]). Conclusions: Young MSM and TGW demonstrated decreased healthcare engagement and higher incidence of HIV and other STIs as compared to older participants in this Nigerian cohort. Interventions to address unique obstacles to healthcare engagement by adolescents and young adults are needed to curb the spread of HIV and other STIs among MSM and TGW in Nigeria. [ABSTRACT FROM AUTHOR]

Introduction: Female sex workers (FSWs) experience overlapping burdens of HIV, sexually transmitted infections and unintended pregnancy. Pre‐exposure prophylaxis (PrEP) is highly efficacious for HIV prevention. It represents a promising strategy to reduce HIV acquisition risks among FSWs specifically given complex social and structural factors that challenge consistent condom use. However, the potential impact on unintended pregnancy has garnered little attention. We discuss the potential concerns and opportunities for PrEP to positively or negatively impact the sexual and reproductive health and rights (SRHR) of FSWs. Discussion: FSWs have high unmet need for effective contraception and unintended pregnancy is common in low‐ and middle‐income countries. Unintended pregnancy can have enduring health and social effects for FSWs, including consequences of unsafe abortion and financial impacts affecting subsequent risk‐taking. It is possible that PrEP could negatively impact condom and other contraceptive use among FSWs due to condom substitution, normalization, external pressures or PrEP provision by single‐focus services. There are limited empirical data available to assess the impact of PrEP on pregnancy rates in real‐life settings. However, pregnancy rates are relatively high in PrEP trials and modelling suggests a potential two‐fold increase in condomless sex among FSWs on PrEP, which, given low use of non‐barrier contraceptive methods, would increase rates of unintended pregnancy. Opportunities for integrating family planning with PrEP and HIV services may circumvent these concerns and support improved SRHR. Synergies between PrEP and family planning could promote uptake and maintenance for both interventions. Integrating family planning into FSW‐focused community‐based HIV services is likely to be the most effective model for improving access to non‐barrier contraception among FSWs. However, barriers to integration, such as provider skills and training and funding mechanisms, need to be addressed. Conclusions: As PrEP is scaled up among FSWs, there is growing impetus to consider integrating family planning services with PrEP delivery in order to better meet the diverse SRHR needs of FSWs and to prevent unintended consequences. Programme monitoring combined with research can close data gaps and mobilize adequate resources to deliver comprehensive SRHR services respectful of all women's rights. [ABSTRACT FROM AUTHOR]

Keywords: HIV/HCV co-infection; people living with HIV; elimination; direct-acting antivirals; behaviour EN HIV/HCV co-infection people living with HIV elimination direct-acting antivirals behaviour 1 3 3 07/30/20 20200701 NES 200701 Hepatitis C virus (HCV) infects an estimated 71 million people, including over two million with HIV/HCV coinfection [1]. Nevertheless, maintaining HCV treatment rates in PLHIV requires vigilance; treatment uptake varies across risk groups. Combined needle and syringe programmes and opioid agonist therapy reduce HCV risk by 85% among PWID [11], but low harm reduction (HR) programme coverage in most countries threatens HCV elimination. A Swiss HIV/HCV coinfection model of the potential epidemic effects of DAA scale-up predicted that reinfections will increase as a proportion of incident infections among GBM living with HIV (e.g. 44% of all incident infections in 2030, assuming increased risk behaviour) [13]. [Extracted from the article]

Abstract: Introduction: We determined the contribution of undiagnosed HIV to new infections among gay and bisexual men (GBM) over a 12‐year period in Australia where there has been increasing focus on improving testing and HIV treatment coverage. Methods: We generated annual estimates for each step of the HIV cascade and the number of new HIV infections for GBM in Australia over 2004 to 2015 using relevant national data. Using Bayesian melding we then fitted a quantitative model to the cascade and incidence estimates to infer relative transmission coefficients associated with being undiagnosed, diagnosed and not on ART, on ART with unsuppressed virus, or on ART with suppressed virus. Results: Between 2004 and 2015, we estimated the percentage of GBM with HIV in Australia who were unaware of their status to have decreased from 14.5% to 7.5%. During the same period, there was a substantial increase in the number and proportion of GBM living with HIV on treatment and with suppressed virus, with the number of virally suppressed GBM increasing from around 3900 (30.2% of all GBM living with HIV) in 2004 to around 14,000 (73.7% of all GBM living with HIV) in 2015. Despite the increase in viral suppression, the annual number of new infections rose from around 660 to around 760 over this period. Our results have a wide range due to the uncertainty in the cascade estimates and transmission coefficients. Nevertheless, undiagnosed GBM increasingly appear to contribute to new infections. The proportion of new infections attributable to undiagnosed GBM almost doubled from 33% in 2004 to 59% in 2015. Only a small proportion (<7%) originated from GBM with suppressed virus. Discussion: Our study suggests that an increase in HIV treatment coverage in Australia has reduced the overall risk of HIV transmission from people living with HIV. However, the proportion of infections and the rate of transmission from undiagnosed GBM has increased substantially. These findings highlight the importance of HIV testing and intensified prevention for Australian GBM at high risk of HIV. [ABSTRACT FROM AUTHOR]

Introduction Globally, young gay, bisexual and other men who have sex with men (gb MSM) continue to experience disproportionately high rates of HIV and other sexually transmitted and blood-borne infections ( STBBIs). As such, there are strong public health imperatives to evaluate innovative prevention, treatment and care interventions, including online interventions. This study reviewed and assessed the status of published research (e.g. effectiveness; acceptability; differential effects across subgroups) involving online interventions that address HIV/ STBBIs among young gb MSM. Methods We searched Medline, Embase, PsycINFO, CINAHL, and Google Scholar to identify relevant English-language publications from inception to November 2016. Studies that assessed an online intervention regarding the prevention, care, or treatment of HIV/ STBBIs were included. Studies with <50% gbMSM or with a mean age ≥30 years were excluded. Results Of the 3465 articles screened, 17 studies met inclusion criteria. Sixteen studies assessed interventions at the 'proof-of-concept' phase, while one study assessed an intervention in the dissemination phase. All of the studies focused on behavioural or knowledge outcomes at the individual level (e.g. condom use, testing behaviour), and all but one reported a statistically significant effect on ≥1 primary outcomes. Twelve studies described theory-based interventions. Twelve were conducted in the United States, with study samples focusing mainly on White, African-American and/or Latino populations; the remaining were conducted in Hong Kong, Peru, China, and Thailand. Thirteen studies included gay and bisexual men; four studies did not assess sexual identity. Two studies reported including both HIV+ and HIV− participants, and all but one study included one or more measure of socio-economic status. Few studies reported on the differential intervention effects by socio-economic status, sexual identity, race or serostatus. Conclusion While online interventions show promise at addressing HIV/ STBBI among young gb MSM, to date, little emphasis has been placed on assessing: (i) potential differential effects of interventions across subgroups of young gb MSM; (ii) effectiveness studies of interventions in the dissemination phase; and (iii) on some 'key' populations of young gb MSM (e.g. those who are: transgender, from low-income settings and/or HIV positive). Future research that unpacks the potentially distinctive experiences of particular subgroups with 'real world' interventions is needed. [ABSTRACT FROM AUTHOR]

Introduction Adolescence is a time of physical, emotional and social transitions that have implications for health. In addition to being at high risk for HIV, young key populations (YKP) may experience other health problems attributable to high-risk behaviour or their developmental stage, or a combination of both. Discussion We reviewed the needs, barriers and gaps for other non-HIV health services for YKP. We searched PubMed and Google Scholar for articles that provided specific age-related data on sexual and reproductive health; mental health; violence; and substance use problems for adolescent, youth or young sex workers, men who have sex with men, transgender people, and people who inject drugs. Results YKP experience more unprotected sex, sexually transmitted infections including HIV, unintended pregnancy, violence, mental health disorders and substance use compared to older members of key populations and youth among the general population. YKP experience significant barriers to accessing care; coverage of services is low, largely because of stigma and discrimination experienced at both the health system and policy levels. Discussion YKP require comprehensive, integrated services that respond to their specific developmental needs, including health, educational and social services within the context of a human rights-based approach. The recent WHO Consolidated Guidelines on HIV Prevention, Diagnosis, Treatment and Care for Key Populations are an important first step for a more comprehensive approach to HIV programming for YKP, but there are limited data on the effective delivery of combined interventions for YKP. Significant investments in research and implementation will be required to ensure adequate provision and coverage of services for YKP. In addition, greater commitments to harm reduction and rights-based approaches are needed to address structural barriers to access to care. [ABSTRACT FROM AUTHOR]

Introduction HIV diagnoses among gay and bisexual men have increased over the past decade in Australia. HIV point‐of‐care testing (POCT) was introduced in Australia in 2011 as a strategy to increase HIV testing by making the testing process more convenient. We surveyed gay and bisexual men undergoing POCT to assess barriers to HIV testing and characteristics associated with not having previously tested for HIV (never testing). Methods During 2011 and 2012, gay and bisexual men who were undergoing POCT at four Sydney sexual health clinics self‐completed questionnaires assessing testing history and psychological and structural barriers to HIV testing. Bivariate and multivariate logistic regression was used to assess associations between patient characteristics and never testing. Results Of 1093 participants, 981 (89.9%) reported ever testing for HIV and 110 (10.1%) never testing. At least one barrier to testing was reported by 1046 men (95.7%), with only 47 men (4.3%) not reporting any barrier to testing. The most commonly reported barriers to testing were annoyance at having to return for results (30.2%), not having done anything risky (29.6%), stress in waiting for results (28.4%), being afraid of testing positive (27.5%) and having tested recently (23.2%). Never testing was independently associated with being non‐gay‐identified (adjusted odds ratio [AOR]: 1.9; 95% confidence interval [CI]: 1.1–3.2), being aged less than 25 years (AOR: 2.4; 95% CI: 1.6–3.8), living in a suburb with few gay couples (AOR: 1.9; 95% CI: 1.2–3.0), being afraid of testing HIV‐positive (AOR: 1.6; 95% CI: 1.0–2.4), not knowing where to test (AOR: 3.8; 95% CI: 1.3–11.2) and reporting one or no sexual partners in the last six months (AOR: 2.7; 95% CI: 1.2–6.2). Conclusions Barriers to HIV testing were commonly reported among the clinic‐based gay and bisexual men in this study. Our findings suggest further health promotion and prevention strategies are needed to address the knowledge, attitudes and behavioural factors associated with never testing. [ABSTRACT FROM AUTHOR]

Introduction: Achieving the virtual elimination of HIV requires equitable access to HIV prevention tools for all priority populations. Restricted access to healthcare means migrants face particular barriers to HIV prevention services. In February 2016, a peer‐led rapid HIV testing service for gay, bisexual and other men who have sex with men (gay and bisexual men, GBM) in Melbourne, Australia, introduced free sexually transmissible infection (STI) testing funded through Medicare (Australia's universal healthcare system). Medicare ineligible migrant clients were required to pay up to $158AUD for STI tests. We determined the uptake of STI testing and assessed the impact on repeat HIV testing among Medicare eligible and ineligible clients. Methods: All HIV tests conducted between August 2014 and March 2018 were included. We describe client characteristics, STI testing uptake and HIV/STI positivity among Medicare eligible and ineligible clients. Repeat HIV testing, assessed as the percentage of HIV tests with a return test within six months, was compared pre‐integration (August 2014‐June 2016) and post‐integration(July 2016‐March 2018) of STI testing using segmented linear regression of monthly aggregate data for Medicare eligible and ineligible clients. Results: Analyses included 9134 HIV tests among 4753 individuals. Medicare ineligible clients were younger (p < 0.01), and fewer reported previously testing for HIV (p < 0.01) and high HIV risk sexual behaviours. There was no difference in HIV positivity between the two groups (p = 0.09). STI testing uptake was significantly lower among Medicare ineligible clients (7.6%, 85.3%; p < 0.01). Following STI testing introduction there was an immediate increase in six‐month return HIV testing (6.4%; p = 0.02) and a significantly increasing rate of return HIV testing between July 2016 and March 2018 (0.5% per month; p < 0.01) among Medicare eligible clients but no immediate change in return testing (−0.9%; p = 0.7) or the rate of change in return testing between July 2016 and March 2018 (0.1% per month; p = 0.3) among Medicare ineligible clients. In March 2018, six‐month return HIV testing was 52.3% and 13.2% among Medicare eligible and ineligible clients respectively. Discussion: Improvements in return HIV testing observed among Medicare eligible clients did not extend to Medicare ineligible clients highlighting the impact of inequitable access to comprehensive sexual healthcare on test‐and‐treat approaches to HIV prevention. [ABSTRACT FROM AUTHOR]

Introduction: Gay and bisexual men (GBM) are at increased risk of hepatitis C/HIV co‐infection. In Australia, the availability of subsidized direct‐acting antiviral treatment for hepatitis C has rendered eliminating co‐infection possible. High reinfection rates in subgroups with continued exposure may compromise elimination efforts. To inform the development of hepatitis C risk reduction support in GBM, we explored reinfection risk perceptions and attitudes among GBM living with HIV recently cured from hepatitis C. Methods: Between April and August 2017, 15 GBM living with diagnosed HIV were recruited from high caseload HIV primary care services in Melbourne following successful hepatitis C treatment. In‐depth interviews were conducted exploring understandings of hepatitis C risks, experiences of co‐infection and attitudes towards reinfection. Constructivist grounded theory guided data aggregation. Results: Participants' understandings of their hepatitis C infection and reinfection trajectories were captured in three categories. Hepatitis C and HIV disease dichotomies: Hepatitis C diagnosis was a shock to most participants and contrasted with feelings of inevitability associated with HIV seroconversion. While HIV was normalized, hepatitis C was experienced as highly stigmatizing. Despite injecting drug use, interviewees did not identify with populations typically at risk of hepatitis C. Risk environments and avoiding reinfection: Interviewees identified their social and sexual networks as risk‐perpetuating environments where drug use was ubiquitous and higher risk sex was common. Avoiding these risk environments to avoid reinfection resulted in community disengagement, leaving many feeling socially isolated. Hepatitis C care as a catalyst for change: Engagement in hepatitis C care contributed to a better understanding of hepatitis C risks. Interviewees were committed to applying their improved competencies around transmission risk reduction to avoid reinfection. Interviewees also considered hepatitis C care as a catalyst to reduce their drug use. Conclusions: Hepatitis C/HIV co‐infection among GBM cannot be understood in isolation from co‐occurring drug use and sex, nor as separate from their HIV infection. Hepatitis C prevention must address subcultural heterogeneity and the intersectionality between multiple stigmatized social identities. Hepatitis C care presents an opportunity to provide support beyond cure. Peer support networks could mitigate social capital loss following a commitment to behaviour change and reduce hepatitis C reinfection risks. [ABSTRACT FROM AUTHOR]

ORAL ABSTRACT Resident microbiota enhance HIV acquisition, replication and pathogenesis in vivo A. Wahl[sup.1] , W. Yao[sup.1] , B. Liao[sup.1] , M. Chateau[sup.1] , C. Richardson[sup.1] , L. Ling[sup.1] , [...]

Introduction: The human immunodeficiency virus 1 (HIV-1) pandemic is characterized by numerous distinct sub-epidemics (clusters) that continually fuel local transmission. The aims of this study were to identify active growing clusters, to understand which factors most influence the transmission dynamics, how these vary between different subtypes and how this information might contribute to effective public health responses. Methods: We used HIV-1 genomic sequence data linked to demographic factors that accounted for approximately 70% of all new HIV-1 notifications in New South Wales (NSW). We assessed differences in transmission cluster dynamics between subtype B and circulating recombinant form 01AE (CRF01AE). Separate phylogenetic trees were estimated using 2919 subtype B and 473 CRF01AE sequences sampled between 2004 and 2018 in combination with global sequence data and NSW-specific clades were classified as clusters, pairs or singletons. Significant differences in demographics between subtypes were assessed with Chi-Square statistics. Results: We identified 104 subtype B and 11 CRF01AE growing clusters containing a maximum of 29 and 11 sequences for subtype B and CRF01AE respectively. We observed a > 2-fold increase in the number of NSW-specific CRF01AE clades over time. Subtype B clusters were associated with individuals reporting men who have sex with men (MSM) as their transmission risk factor, being born in Australia, and being diagnosed during the early stage of infection (p < 0.01). CRF01AE infections clusters were associated with infections among individuals diagnosed during the early stage of infection (p < 0.05) and CRF01AE singletons were more likely to be from infections among individuals reporting heterosexual transmission (p < 0.05). We found six subtype B clusters with an above-average growth rate (>1.5 sequences / 6-months) and which consisted of a majority of infections among MSM. We also found four active growing CRF01AE clusters containing only infections among MSM. Finally, we found 47 subtype B and seven CRF01AE clusters that contained a large gap in time (>1 year) between infections and may be indicative of intermediate transmissions via undiagnosed individuals. Conclusions: The large number of active and growing clusters among MSM are the driving force of the ongoing epidemic in NSW for subtype B and CRF01AE. Keywords: HIV1; transmission cluster; subtype B and CRF01AE; demographic differences; early infections; public health, 1 | INTRODUCTION Australia is at the forefront of successful control of human immunodeficiency virus type 1 (HIV-1) transmission due to rapid and comprehensive public health responses from the beginning [...]

ORAL ABSTRACTS OA01.01 Evaluation of the kinetics of systemic distribution of IV injected monoclonal antibodies modified to alter host mediated Fc interaction in the rhesus macaque model A.M. Carias[sup.1], J. [...]

MOAA0101 Assessing individual viral reactivations of the latent reservoir using a novel barcoded virus C Fennessey[sup.1]; M Pinkevych[sup.2]; T Immonen[sup.1]; C Camus[sup.1]; G Del Prete[sup.1]; J Estes[sup.1]; J Lifson[sup.1]; M [...]

HIV and adolescents: focus on young key populations Editorial Building our youth for the future Supplementary Material Tailored combination prevention packages and PrEP for young key populations Click here for [...]