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Ambitious World Health Organization targets for disease elimination require monitoring of epidemics using routine health data in settings of decreasing and low incidence. We evaluated 2 methods commonly applied to routine testing results to estimate incidence rates that assume a uniform probability of infection between consecutive negative and positive tests based on 1) the midpoint of this interval and 2) a randomly selected point in this interval. We compared these with an approximation of the Poisson binomial distribution, which assigns partial incidence to time periods based on the uniform probability of occurrence in these intervals. We assessed bias, variance, and convergence of estimates using simulations of Weibull-distributed failure times with systematically varied baseline incidence and varying trend. We considered results for quarterly, half-yearly, and yearly incidence estimation frequencies. We applied the methods to assess human immunodeficiency virus (HIV) incidence in HIV-negative patients from the Treatment With Antiretrovirals and Their Impact on Positive and Negative Men (TAIPAN) Study, an Australian study of HIV incidence in men who have sex with men, between 2012 and 2018. The Poisson binomial method had reduced bias and variance at low levels of incidence and for increased estimation frequency, with increased consistency of estimation. Application of methods to real-world assessment of HIV incidence found decreased variance in Poisson binomial model estimates, with observed incidence declining to levels where simulation results had indicated bias in midpoint and random-point methods. [ABSTRACT FROM AUTHOR]

Background To determine participants' human immunodeficiency virus (HIV) risk, the Australian preexposure prophylaxis (PreEPX) trial used 6 eligibility criteria derived from the US Centers for Disease Control and Prevention PrEP guidelines. Participants who fulfilled no eligibility criteria could be enrolled if clinically assessed to need PrEP. This study evaluated whether PREPX eligibility criteria correlated with biological HIV risk markers—namely, syphilis, anorectal chlamydia, or anorectal gonorrhea (sexually transmitted infections [STIs]). Methods We calculated adjusted odds ratios (aORs) to assess whether eligibility criteria predicted STI diagnoses at enrollment. Results We included 1774 participants, of whom 10.2% tested positive for STIs. Eligibility criteria predicted STI diagnoses as follows: (1) aOR 2.5 (95% confidence interval [CI], 1.4–4.4) for condomless anal intercourse (CLAI) with an HIV-positive regular sexual partner (RSP) with detectable viral load; (2) aOR 1.8 (95% CI, 1.3–2.5) for receptive CLAI with casual sexual partners; (3) aOR 1.8 (95% CI, 1.3–2.5) for previous STIs; (4) aOR 2.1 (95% CI, 1.4–3.0) for methamphetamine use; (5) aOR 0.8 (95% CI,.6–1.1) for unsuccessful condom use; and (6) aOR 1.0 (95% CI,.7–1.4) for insertive CLAI when uncircumcised. Of participants enrolled outside eligibility criteria, 7.1% had STIs. Conclusions Eligibility criteria 1–4 predicted diagnoses of STIs, but eligibility criteria 5 and 6 did not. Our findings support the use of PrEP eligibility criteria recommended in current guidelines. Participants enrolled outside the eligibility criteria had substantial prevalence of STIs, suggesting that people who request PrEP but do not fulfill eligibility criteria may nonetheless need PrEP. [ABSTRACT FROM AUTHOR]

Background: Since 2005, Australian clinicians were advised to undertake quarterly syphilis testing for all sexually active HIV-positive men who have sex with men (MSM). We describe differences in syphilis testing frequency among HIV-positive MSM by clinic testing policies since this recommendation. Methods: Three general practices, two sexual health clinics and two hospital HIV outpatient clinics provided data on HIV viral load and syphilis testing from 2006–2010. Men having ≥1 viral load test per year were included; >95% were MSM. We used Chi-2 tests to assess changes in syphilis testing frequency over time, and differences by clinic testing policy (opt-out, opt-in and risk-based). Results: The proportion of men having HIV viral loads with same-day syphilis tests increased from 37% in 2006 to 63% in 2007 (p<0.01) and 68–69% thereafter. In 2010, same-day syphilis testing was highest in four clinics with opt-out strategies (87%, range:84–91%) compared with one clinic with opt-in (74%, p = 0.121) and two clinics with risk-based strategies (22%, range:20–24%, p<0.01). The proportion of men having ≥3 syphilis tests per year increased from 15% in 2006 to 36% in 2007 (p<0.01) and 36–38% thereafter. In 2010, the proportion of men having ≥3 syphilis tests in a year was highest in clinics with opt-out strategies (48%, range:35–59%), compared with opt-in (39%, p = 0.121) and risk-based strategies (8.4%, range:5.4–12%, p<0.01). Conclusion: Over five years the proportion of HIV-positive men undergoing syphilis testing at recommended frequencies more than doubled, and was 5–6 times higher in clinics with opt-out and opt-in strategies compared with risk-based policies. [ABSTRACT FROM AUTHOR]

The article discusses a study on risk factors for human immunodeficiency virus (HIV) positivity and seroconversion among men who have sex with men (MSM) in Victoria. The study analysed data from MSM who underwent HIV testing at three primary care clinics from April 2006 to June 2009. It was found that independent predictors of HIV seroconversion included a diagnosis of infectious syphilis within two years before the HIV test, having six or more anal sex partners within the last six months and inconsistent condom use with casual partners within the last six months. The authors state that the results of the study highlight the need to focus HIV prevention strategies on high-risk MSM.

The article discusses a study on attitudes and practices of general practitioners (GPs) concerning sexual history taking and human immunodeficiency virus (HIV) screening in men who have sex with men (MSM) in Victoria. The study found that 185 of the 354 GPs who participated in a cross-sectional survey were very likely to consider taking a sexual history from MSM seeking a routine check-up. Some barriers to sexual history taking included time constraints, feeling of being inadequately trained and discomfort when discussing sex. A reduced likelihood for GPs to offer an HIV test was found to be linked with fear of patient embarrassment. The results are said to have shown the need for strategies that will increase the awareness among GPs that sexual health is a priority for MSM.

The article discusses a study that connected the Victorian non-occupational post-exposure prophylaxis service (VNPEPS) database and the Victorian HIV Surveillance Registry to find out the number, rate of incidence and predictive factors of HIV seroconversions among VNPEPS users. The records of male patients who received NPEP in the VNPEPS database were correlated with all entries in the Victorian HIV Surveillance Registry up to May 2008. It was found that frequency of NPEP use was not linked to risk of HIV conversion. An Australian cohort study of men who have sex with men is also discussed, which showed that HIV infection incidence among men presenting to the VNPEPS is lower than HIV incidence in NPEP users.

The article discusses a study which described the attributes and key findings from implementation of a new blood-borne virus (BBV) and sexually transmissible infection (STI) sentinel surveillance system based on routine testing at clinical sites in Victoria. The Victorian Primary Care Network for Sentinel Surveillance (VPCNSS) on BBV and STI was established in 2006 at 17 sites, which targeted populations of men who have sex with men (MSM), young people and injecting drug users (IDU). The study collected demographic and behaviour information from patients undergoing routine HIV or STI testing at these sites and linked with laboratory results. Details of the findings are provided.

The article discusses a study which investigated chlamydia positivity and correlates of chlamydia trachomatis infection in a primary care sentinel surveillance network between April 2006 and June 2009. Results showed 5.6 percent positivity in 12,233 females, 7.7 percent in 10,316 heterosexual males and 6.2 percent in 7,872 percent in men who have sex with men (MSM). Correlates of chlamydia among females were younger age, confidence interval, being born overseas, multiple sex partners and inconsistent condom use with regular sex partners. Correlates of chlamydia among heterosexual men were younger age, being born overseas, symptoms and multiple sex partners. Correlates among MSM were being born overseas, being human immunodeficiency virus (HIV)-positive and multiple anal sex partners.

Background: Gay and bisexual men with undiagnosed HIV contribute disproportionately to HIV transmission in Australia. Methods: In 2014 and 2018, we recruited men at gay venues and events in Sydney. Participants self-completed surveys and provided oral fluid samples for HIV testing. We calculated the prevalence of HIV and undiagnosed infection, and assessed changes in behavior, HIV testing, and the use of pre-exposure prophylaxis. We weighted the samples to adjust for differences in where participants were recruited between rounds. Two-sample tests of proportion were used to compare prevalence estimates and x2 tests to assess differences between the samples. Results: In 2014, 944 men were recruited, and 890 men were recruited in 2018. In 2014, the weighted estimate of HIV prevalence was 6.1% [95% confidence intervals (CI): 4.6 to 7.6], of which 13.8% (95% CI: 5.0 to 22.7) was undiagnosed. In 2018, weighted HIV prevalence was 6.4% (95% CI: 4.8 to 8.0), of which 5.3% (95% CI: 0.5 to 11.1) was undiagnosed. Between 2014 and 2018 among all participants, men reporting at least 10 recent casual partners increased from 22.3% to 27.7% (P = 0.008), condomless anal intercourse with casual partners in the previous 6 months increased from 23.9% to 37.3% (P < 0.001), and sexually transmitted infection diagnoses in the previous year increased from 14.4% to 27.5% (P < 0.001). HIV testing and the use of pre-exposure prophylaxis in the previous 6 months increased from 49.6% to 56.3% (P = 0.004) and 2.0%-21.0% (P < 0.001), respectively. Conclusions: Repeated, bio-behavioral surveillance suggests the prevalence of undiagnosed HIV remains low in Sydney, despite gay and bisexual men reporting more casual sex partners, condomless sex, and sexually transmitted infections. [ABSTRACT FROM AUTHOR]

Objectives: Human immunodeficiency virus self-testing (HIVST) is a promising approach to improve HIV testing coverage. We aimed to understand HIV testing preferences of men who have sex with men (MSM) to optimize HIVST implementation.Methods: Discrete choice experiments (DCEs) were conducted among HIV-negative MSM living in Australia and aged ≥18 years. Men completed 1 of 2 DCEs: DCETest for preferred qualities of HIV testing (price, speed, window period, test type, and collector of specimen) and DCEKits for preferred qualities of HIVST kits (price, location of access, packaging, and usage instructions). Latent class conditional logit regression was used to explore similarities (or "classes") in preference behavior.Results: Overall, the study recruited 1606 men: 62% born in Australia, who had an average age of 36.0 years (SD 11.7), and a self-reported median of 4 (interquartile range 2-8) sexual partners in the last 6 months. The respondents to DCETest was described by 4 classes: "prefer shorter window period" (36%), "prefer self-testing" (27%), "prefer highly accurate tests" (22%), and "prefer low prices" (15%). Respondents to DCEKits were described by 4 classes: "prefer low prices" (48%), "prefer retail access (from pharmacy or online stores)" (29%), "prefer access at sex venues" (15%), and "prefer to buy from healthcare staff" (12%). Preferences varied by when someone migrated to Australia, age, frequency of testing, and number of sexual partners.Conclusion: A subset of MSM, particularly infrequent testers, value access to HIVST. Expanding access to HIVST kits through online portals and pharmacies and at sex venues should be considered. [ABSTRACT FROM AUTHOR]