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Objective: Determine the acceptability and epidemiological impact of increases in HIV testing in gay men in New South Wales (NSW), Australia- particularly pertinent when considering treatment as prevention and the need to reduce undiagnosed infections., Methods: We conducted an online survey and focus groups to assess whether increases in HIV testing would be acceptable to gay men in NSW. In parallel, we assessed the potential impact of increases in testing coverage and/or frequency using an individual-based model of HIV transmission., Results: If sexual practices and the rate of initiating HIV treatment are unchanged then increasing HIV testing reduces infections. Increasing testing frequency has the largest impact, with a 13.8% reduction in HIV infections over 10 years if the ∼55-75% of men who test at least once per year increased their testing frequency to four times per year. If testing levels decrease from current levels then we expect an increase in HIV infections with a sharply rising trend over time. Increasing HIV testing would be acceptable if testing was more convenient. However, only ∼25% of men surveyed were 'very likely' to increase their level of HIV testing. Men delayed or avoided testing due to the slowness in obtaining results and if they believed they had not put themselves at risk., Conclusions: An increase in HIV testing alone is unlikely to reduce HIV incidence substantially in NSW gay men- however, the relatively high testing levels need to continue to prevent an increase in HIV infections. In jurisdictions with lower levels of HIV testing, increases in testing coverage and frequency are likely to have a larger impact. Successful treatment as prevention interventions will require increases in testing rates; such increases would be acceptable to gay men in NSW but only if more convenient testing and rapid communication of results were available.

Background: Universal access to first-line antiretroviral therapy (ART) for HIV infection is becoming more of a reality in most low and middle income countries in Asia. However, second-line therapies are relatively scarce., Methods and Findings: We developed a mathematical model of an HIV epidemic in a Southeast Asian setting and used it to forecast the impact of treatment plans, without second-line options, on the potential degree of acquisition and transmission of drug resistant HIV strains. We show that after 10 years of universal treatment access, up to 20% of treatment-naïve individuals with HIV may have drug-resistant strains but it depends on the relative fitness of viral strains., Conclusions: If viral load testing of people on ART is carried out on a yearly basis and virological failure leads to effective second-line therapy, then transmitted drug resistance could be reduced by 80%. Greater efforts are required for minimizing first-line failure, to detect virological failure earlier, and to procure access to second-line therapies.

The article discusses a study which investigated whether the National Gay Men's Syphilis Action Plan (NGMSAP) in Australia has an indirect impact on the human immunodeficiency virus (HIV) epidemic in the country. The NGMSAP was developed with the aim of reducing the number of syphilis cases among gay men. An agent-based computer model was developed under the study to simulate HIV and syphilis transmission and progression among sexually active gay men in Victoria. The model showed that effective implementation of the syphilis action plan will lead to a 48% decline in number of HIV infections over the next ten years even without HIV interventions.

The article discusses research on the potential impact of the implementation of the Australian National Gay Men's Syphilis Action Plan (NGMSAP) on the increasing incidence rates of syphilis and HIV particularly among men who have sex with men (MSM). It aims to investigate whether a resurgent syphilis epidemic contributes to the growing cases of HIV in the country. Details on the development of NGMSAP by the Australian Population Health Development Principal Committee are reported. It also outlines the parameters considered for the study which include overall duration of infectious syphilis, duration of incubation period, and HIV transmission probability per act in chronic stage.

Abstract: Background: The RV144 trial conducted in Thailand was the first to demonstrate modest protective efficacy of an HIV vaccine. Its estimated initial efficacy was ∼74%, but this waned considerably over time. Methods: We developed a mathematical model to reflect historical and current HIV trends across different at-risk populations in Thailand. The model was used to estimate the expected number of infections that would be averted if a vaccine with outcome characteristics similar to the RV144 vaccine was implemented in Thailand at varying levels of coverage. Results: In the absence of a vaccine, we projected roughly 65,000 new HIV infections among adults during the period between 2011 and 2021. Due to the waning efficacy of the vaccine, vaccination campaigns were found to have modest long-term public health benefit unless re-vaccination occurred. We forecast that an RV144-like vaccine with coverage of 30% of the population would lead to a 3% reduction in HIV incidence during the next 10 years. In comparison, 30% coverage of annual or biennial re-vaccination with the vaccine was found to result in 23% and 14% reductions in incidence, respectively. Coverage of 60% without re-vaccination resulted in a 7% reduction. Epidemiological outcomes were found to depend primarily on three factors: vaccination coverage, vaccine efficacy, and the duration of protection the vaccine provided. Discussion: Due to the short duration of protection the vaccine provides without re-vaccination, our model predicts modest benefit from a vaccination campaign with an RV144-like HIV vaccine in Thailand. Annual or biannual re-vaccination is predicted to greatly increase the long-term public health benefits of a vaccination campaign. The feasibility of vaccine implementation, as well as its economic viability, remains to be determined. [Copyright &y& Elsevier]