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STI and HIV surveillance and monitoring information was analysed to explain when the fall in HIV in MSM in England began and why. The HIV incidence fall began in 2013 much earlier than for HIV diagnoses. The strongest explanation is intensification of HIV testing and large time to treatment reduction.Background: A fall in new HIV infection diagnoses in MSM occurred in England between 2012 and 2016 when prevention policies were introduced or strengthened; HIV test frequency increased; time to treatment initiation reduced; HIV PrEP began. Important implementation lessons may be learnt by evaluating the contribution of each policy. Early results (Eurosurveillance June 2017) have been strengthened with additional information. Methods: Descriptive analyses of surveillance and monitoring information on MSM clinic attendances, HIV diagnoses, HIV tests, and STI diagnoses were conducted, including stratification by clinic throughput volume. Back-calculation analyses of underlying HIV incidence was updated with data through 2016 and after exclusion of HIV diagnoses made abroad. Results: After peaking at 2,946 in 2014, new HIV infection diagnoses fell to 2,102 in 2016. Estimated underlying HIV incidence peaked earlier at an estimated 2,670 infections in 2012 and fell thereafter beginning at 2,500 in 2013, accelerating down to 2,150 in 2014, 1,755 in 2015, and 1,470 in 2016. During the period 2012 through 2015 when the fall began, the following happened: diagnoses of gonorrhoea and syphilis increased steadily; MSM clinic attendances and HIV testing increased markedly; the time to treatment initiation of 90% of MSM with CD4 over 350 at diagnosis decreased from 43 to 21 months in London and from 45 to 31 months elsewhere; the estimated number taking PrEP increased to 200 by end 2013 and 500 by end 2014. Conclusions: The strongest explanation for the fall in HIV incidence is an intensification of HIV testing coupled with a large shortening of the time to treatment initiation. During the initial period the PrEP effect was probably small though will have increased through 2015 and 2016. Treatment as prevention can control HIV transmission in communities that are densely networked sexually, provided testing is very frequent and treatment initiation is immediate.

[English]:This book belongs to a new Series promoted by the School of Humanities and Social Sciences at Federico II University of Naples, in order to facilitate dialogue among scholars from different disciplines and to encourage interdisciplinary and cross-sectoral approaches on topics, both contemporary and historical. The studies collected in this volume offer a graceful synthesis of past and present, as is typical of the humanities, that study human culture in all its form. / [Italiano]: Gli studi raccolti in questo volume costituiscono il primo ‘Quaderno’ della nuova Collana di pubblicazioni della Scuola di Scienze Umane e Sociali dell’Ateneo fridericiano, promossa con l’intendimento di facilitare il confronto e il dialogo tra studiosi di varia provenienza, di sollecitare indagini trasversali e interdisciplinari sia su argomenti lontani nel tempo sia su temi di grande attualità che sono parte del nostro vissuto quotidiano. Il volume rappresenta una felice sintesi tra passato e presente, come è prerogativa delle ricerche appartenenti alla cultura umanistica, che ha a oggetto lo studio dell’esperienza umana considerata nella sua globalità.

CD4-based multi-state back-calculation methods are key for monitoring the HIV epidemic, providing estimates of HIV incidence and diagnosis rates by disentangling their inter-related contribution to the observed surveillance data. This paper, extends existing approaches to age-specific settings, permitting the joint estimation of age- and time-specific incidence and diagnosis rates and the derivation of other epidemiological quantities of interest. This allows the identification of specific age-groups at higher risk of infection, which is crucial in directing public health interventions. We investigate, through simulation studies, the suitability of various bivariate splines for the non-parametric modelling of the latent age- and time-specific incidence and illustrate our method on routinely collected data from the HIV epidemic among gay and bisexual men in England and Wales. Electronic supplementary material The online version of this article (10.1007/s10985-019-09465-1) contains supplementary material, which is available to authorized users.