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Objectives: We conducted a survey to evaluate HIV pre‐exposure prophylaxis (PrEP) practices in a European clinical research network on HIV, hepatitis, and global infectious diseases (NEAT ID). Methods: An online survey comprising 22 questions was sent via a secure electronic tool to the investigating physician of each of the 342 NEAT ID study centres across 15 European countries in November 2020. Results: In total, 50 sites from 12 countries responded (15% response rate). Most sites were in Western Europe, two were in Poland, and one was in Hungary. Of the responding sites, 45 provided PrEP services for a total of 27 416 PrEP users, with 1361 new PrEP initiators each month. These centres supplied PrEP for men who have sex with men (100%), people who inject drugs (84%), sex workers (84%), women (62%), and transgender women (31%). PrEP persistence after 1 year was >90%, 75%–90%, and 40%–75% in 17, 24, and 4 centres, respectively. In total, 32/45 (71%) centres reported strong community‐based organization commitment at their site, and 15/45 (33%) centres developed task‐shifting processes to deliver PrEP through nurses (11/15), pharmacists (5/15), and key‐population peers (2/15). The biggest barriers to implementation of PrEP were low awareness of and knowledge about PrEP (47%), unwillingness to disclose sexual identity or at‐risk behaviour (36%), and lack of administrative support (29%). Of the 45 centres, 32 (71%) have already been involved in PrEP research and 43 (96%) were interested in participating in such studies. Conclusions: The few NEAT ID centres that responded to the survey showed disparities in PrEP deployment and practices despite a common interest in participating in research in this field. [ABSTRACT FROM AUTHOR]

Objectives: HIV disproportionately affects men who have sex with men (MSM) in Ireland. The aim of this study was to improve understanding of HIV testing among MSM living in Ireland to inform prevention and testing initiatives. Methods: We used data from the MSM Internet Survey Ireland 2015 (MISI 2015), a cross‐sectional survey of MSM living in Ireland. We identified factors associated with never having tested for HIV using univariable and multivariable logistic regression. We identified preferred sites for future tests and examined the relationships between unmet HIV testing needs and socio‐demographic groups. Results: More than one‐third (n = 1006; 36%) of MSM had never tested for HIV. Multivariable logistic regression showed that untested men were more likely to be aged 18–24 years, live outside Dublin, have a lower level of education, be born in Ireland, identify as bisexual, be out to fewer people, and not have had sex with a man in the previous 12 months. The same groups of men also had the least knowledge about HIV and were least confident in accessing an HIV test. Men who had never tested for HIV were more likely to prefer testing by their general practitioner (GP) or using home sampling HIV kits and less likely to prefer testing in a sexual health clinic. Conclusions: HIV prevention and testing programmes for MSM should be targeted towards younger men, those living outside Dublin and those with lower levels of education. We recommend increased promotion and availability of free HIV testing services in a range of clinical and nonclinical settings (including self‐sampling and home testing). [ABSTRACT FROM AUTHOR]

Objectives: Pre‐exposure prophylaxis (PrEP) is an effective HIV prevention tool for high‐risk men who have sex with men (MSM). However, acceptability and uptake have been variable. This study explored the factors that predict PrEP acceptability in MSM in Leicester, where HIV prevalence is double the national average. Methods: A total of 191 HIV‐negative MSM completed a cross‐sectional survey. Participants provided demographic information, and completed measures of HIV knowledge, perceived HIV risk, engagement in sexual risk behaviour, acquisition of a sexually transmitted infection (STI) in the last 12 months, frequency of HIV testing and PrEP acceptability. Results: Kruskal–Wallis tests showed statistically significant effects of sexual orientation, education level and income, respectively, on HIV knowledge. Gay‐identified individuals possessed greater HIV knowledge than bisexuals. Respondents with General Certificate of Secondary Education (GCSE)‐level education had significantly less HIV knowledge than those educated to postgraduate level. Respondents with income of < £10 000 possessed significantly less HIV knowledge than higher income groups. Structural equation modelling showed that the relationship between HIV knowledge and PrEP acceptability was mediated by perceived HIV risk, engagement in sexual risk behaviour, acquisition of an STI in the past 12 months and frequency of HIV testing. Conclusions: The results reveal socio‐economic inequalities in HIV knowledge and HIV testing, and suggest that MSM who have high levels of HIV knowledge and perceived HIV risk and who regularly test for HIV are most likely to endorse PrEP as personally beneficial. HIV knowledge and accurate risk appraisal should be promoted in MSM. The HIV testing context constitutes an ideal context for promoting PrEP to high‐risk MSM. [ABSTRACT FROM AUTHOR]

Objectives: Despite the huge success of antiretroviral therapy (ART), there is an ongoing HIV epidemic among men who have sex with men (MSM) in resource‐rich countries. Understanding the driving factors underlying this process is important for curbing the epidemic. Methods: We simulated the HIV epidemic in MSM in Switzerland by stratifying a mathematical model by CD4 count, the care cascade and condom use. The model was parametrised with clinical, epidemiological and behavioural data from the Swiss HIV Cohort Study and surveys in the HIV‐negative population. Results: According to our model, 3.4% of the cases that would otherwise have occurred in 2008–2015 were prevented by early initiation of ART. Only 0.6% of the cases were attributable to a change in condom use in the HIV‐positive population, as less usage is mainly seen in virally suppressed MSM. Most new infections were attributable to transmission from recently infected undiagnosed individuals. It was estimated that doubling the diagnosis rate would have resulted in 11.8% fewer cases in 2001–2015. Moreover, it was estimated that introducing pre‐exposure prophylaxis (PrEP) for 50% of those MSM not using condoms with occasional partners would have resulted in 22.6% fewer cases in 2012–2015. Conclusions: By combining observational data on the relevant epidemiological and clinical processes with a mathematical model, we showed that the 'test and treat' approach is most effective in reducing the number of new cases. Only a moderate population‐level effect was estimated for early initiation of ART and a weak effect for the change in condom use of diagnosed MSM. Protecting HIV‐negative individuals who are not using condoms with PrEP was shown to have a major impact. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the study was to measure and compare national continuum of HIV care estimates in Europe and Central Asia in three key subpopulations: men who have sex with men (MSM), people who inject drugs (PWID) and migrants. Methods: Responses to a 2016 European Centre for Disease Prevention and Control (ECDC) survey of 55 European and Central Asian countries were used to describe continuums of HIV care for the subpopulations. Data were analysed using three frameworks: Joint United Nations Programme on HIV/AIDS (UNAIDS) 90‐90‐90 targets; breakpoint analysis identifying reductions between adjacent continuum stages; quadrant analysis categorizing countries using 90% cut‐offs for continuum stages. Results: Overall, 29 of 48 countries reported national data for all HIV continuum stages (numbers living with HIV, diagnosed, receiving treatment and virally suppressed). Six countries reported all stages for MSM, seven for PWID and two for migrants. Thirty‐one countries did not report data for MSM (34 for PWID and 41 for migrants). In countries that provided key‐population data, overall, 63%, 40% and 41% of MSM, PWID and migrants living with HIV were virally suppressed, respectively (compared with 68%, 65% and 68% nationally, for countries reporting key‐population data). Variation was observed between countries, with higher outcomes in subpopulations in Western Europe compared with Eastern Europe and Central Asia. Conclusions: Few reporting countries can produce the continuum of HIV care for the three key populations. Where data are available, differences exist in outcomes between the general and key populations. While MSM broadly mirror national outcomes (in the West), PWID and migrants experience poorer treatment and viral suppression. Countries must develop continuum measures for key populations to identify and address inequalities. [ABSTRACT FROM AUTHOR]

Objectives HIV self-testing (HIVST) offers an opportunity to increase HIV testing among people not reached by facility-based services. However, the promotion of HIVST is limited as a consequence of insufficient community engagement. We built a social entrepreneurship testing (SET) model to promote HIVST linkage to care among Chinese men who have sex with men (MSM) in Guangzhou. Methods The SET model includes a few key steps. Each participant first completed an online survey, and paid a US$23 (refundable) deposit to receive an HIVST kit and a syphilis self-testing (SST) kit. After the testing, the results were sent to the platform by the participants and interpreted by Center for Disease Control and Prevention (CDC) staff. Meanwhile, the deposit was returned to each participant. Finally, the Community based organizations (CBO) contacted the participants to provide counselling services, confirmation testing and linkage to care. Results During April June 2015, a total of 198 MSM completed a preliminary survey and purchased selftesting kits. The majority were aged < 34 years (84.4%) and met partners online (93.1%). In addition, 68.9% of participants had ever been tested for HIV, and 19.5% had ever performed HIVST. Overall, feedback was received from 192 participants (97.0%). Of these participants, 14 people did not use the kits; among those who did use the kits, the HIV and syphilis prevalences were 4.5% (eight of 178) and 3.7% (six of 178), respectively. All of the screened HIV-positive individuals sought further confirmation testing and were linked to care. Conclusions Using an online SET model to promote HIV and syphilis self-testing among Chinese MSM is acceptable and feasible, and this model adds a new testing platform to the current testing service system. [ABSTRACT FROM AUTHOR]

Objectives The aim of the study was to explore HIV testing frequency among UK men who have sex with men ( MSM) in order to direct intervention development. Methods Cross-sectional surveys were completed by 2409 MSM in Edinburgh, Glasgow and London in 2011 and a Scotland-wide online survey was carried out in 2012/13. The frequency of HIV testing in the last 2 years was measured. Results Overall, 21.2% of respondents reported at least four HIV tests and 33.7% reported two or three tests in the last 2 years, so we estimate that 54.9% test annually. Men reporting at least four HIV tests were younger and less likely to be surveyed in London. They were more likely to report higher numbers of sexual and anal intercourse partners, but not 'higher risk' unprotected anal intercourse ( UAI) with at least two partners, casual partners and/or unknown/discordant status partners in the previous 12 months. Only 26.7% (238 of 893) of men reporting higher risk UAI reported at least four tests. Among all testers ( n = 2009), 56.7% tested as part of a regular sexual health check and 35.5% tested following a risk event. Differences were observed between surveys, and those testing in response to a risk event were more likely to report higher risk UAI. Conclusions Guidelines recommend that all MSM test annually and those at 'higher risk' test more frequently, but our findings suggest neither recommendation is being met. Additional efforts are required to increase testing frequency and harness the opportunities provided by biomedical HIV prevention. Regional, demographic and behavioural differences and variations in the risk profiles of testers suggest that it is unlikely that a 'one size fits all' approach to increasing the frequency of testing will be successful. [ABSTRACT FROM AUTHOR]

Objectives To describe HIV testing behaviour and context of MSM in Portugal participating in the European MSM Internet Survey (EMIS). Methods Data for the Portuguese sample were extracted and those for 5187 participants were analysed. Multivariate logistic regression models were fitted to quantify the association between participants' characteristics and HIV testing behaviour and context. Results Seventy-two percent of the participants had ever been tested for HIV and among those ever tested, 11% were diagnosed with HIV. Primary care was the most common testing setting for HIV-negative men (37%). Compared to those never tested, men who had ever taken an HIV test had higher educational level (aOR 1.89, 95% CI 1.67-2.14) and identified themselves as gay/homosexual more frequently (aOR 1.94 , 95% CI 1.70-2.20). HIV testing odds significantly increased with the number of sexual partners in the previous 12 months. Those who reported unprotected anal intercourse (UAI) with a partner of unknown or serodiscordant HIV status in the previous 12 months were less likely to report an HIV test (aOR 0.38, 95% CI 0.33-0.44). Among those never tested or who tested negative, 41% and 22% reported UAI with a partner of unknown or serodiscordant status in the previous 12 months, respectively. Among men with diagnosed HIV, 72% were currently on antiretroviral therapy and 58% reported an undetectable viral load. More than one third (38%) of those who had detectable or unknown/undisclosed viral load reported at least one episode of UAI with a partner of unknown or serodiscordant HIV status in the last 12 months. Conclusions Actual interventions should focus on: improving testing uptake and counselling; increasing treatment coverage; achieving and maintaining an undetectable viral load; and intensifying prevention efforts focused on consistent condom use. [ABSTRACT FROM AUTHOR]

Objectives The aims of the study were to describe the sociodemographic profile of men who have sex with men ( MSM) who have never been tested for HIV and to analyse factors associated with never having been tested. Methods The European MSM Internet Survey ( EMIS) was implemented in 2010 in 38 European countries on websites for MSM and collected data on sociodemographics, sexual behaviour, and other sexual health variables. A logistic regression analysis was conducted to assess variables associated with never having been tested for HIV. Results Of the 13 111 respondents living in Spain, 26% had never been tested for HIV. Those who had never been tested were significantly more likely to live in a settlement with fewer than 100 000 inhabitants, be younger than 25 years old, have a lower education level, be a student, and identify themselves as bisexual. In the multivariate analysis, to have never been tested for HIV was associated with being born in Spain [odds ratio ( OR) 1.35; 95% confidence interval ( CI) 1.192-1.539], living outside large settlements ( OR 1.37; 95% CI 1.216-1.534), being younger than 25 years old ( OR 2.94; 95% CI 2.510-3.441), being out to no one or only a few people ( OR 2.16; 95% CI 1.938-2.399), having had no nonsteady partners in the last 12 months ( OR 1.26; 95% CI 1.109-1.422), and being not at all confident to access HIV testing ( OR 3.66; 95% CI 2.676-5.003), among others factors. Conclusions The profile of the MSM who had never been tested for HIV indicates that most of them were men who were hard to reach (young, bisexual men, in the closet). Interventions should aim to improve access to and the convenience of testing. [ABSTRACT FROM AUTHOR]