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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]

Introduction: In Myanmar, men who have sex with men (MSM) and transgender women (TW) are disproportionately affected by HIV, despite national HIV program scale‐up. However, limited HIV surveillance capacity prevents monitoring of epidemic trends and program impact. This study aimed to estimate HIV prevalence and incidence and explore associated sexual risk behaviours among MSM and TW clients attending HIV testing clinics in Myanmar. Methods: An electronic data management system was implemented in two community‐based, MSM and TW ‐tailored HIV testing clinics in Myanmar in August 2016. Unique client identifiers enabled prospective monitoring of service engagement, testing frequency and outcomes. We estimated HIV incidence and rate of HIV diagnosis at baseline testing visit among clients over a 15 month period. Correlates of HIV diagnoses were identified using multivariable logistic regression. Results: 2794 MSM and TW were tested for HIV. At their baseline test, 38% of clients reported any previous testing and 93% reported being sexually active over the previous three months, with 74% reporting sex with casual male partners and 28% reporting consistent condom use with casual partners. 291 clients tested positive for HIV for the first time at baseline (10.4%; 95% CI: 9.3 to 11.6). Twelve incident cases were detected among 279 clients receiving ≥2 tests (incidence = 10.1 per 100 person‐years; 95% CI: 5.73 to 17.8). HIV diagnosis at baseline was significantly associated with being a transgender woman or a non‐openly disclosing man who has sex with men, age 26 to 39 years, and reporting no testing history. Conclusions: High HIV incidence and new diagnoses being associated with reporting no testing history points to undiagnosed HIV driving transmissions in Myanmar. Repeat testing was uncommon. HIV programs in Myanmar must focus on promoting frequent HIV testing alongside adequate coverage of education and primary prevention interventions among MSM and TW. [ABSTRACT FROM AUTHOR]

Introduction: Broad availability of direct-acting antiviral therapy for hepatitis C virus (HCV) raises the possibility that HCV prevalence and incidence can be reduced through scaling-up treatment, leading to the elimination of HCV. High rates of linkage to HIV care among HIV-infected gay and bisexual men may facilitate high uptake of HCV treatment, possibly making HCV elimination more achievable in this group. Areas covered: This review covers HCV elimination in HIV-infected gay and bisexual men, including epidemiology, spontaneous clearance and long term sequelae in the absence of direct-acting antiviral therapy; direct-acting antiviral therapy uptake and effectiveness in this group; HCV reinfection following successful treatment; and areas for further research. Expert commentary: Early data from the direct-acting antiviral era suggest that treatment uptake is increasing among HIV infected GBM, and SVR rates are very promising. However, in order to sustain current treatment rates, additional interventions at the behavioral, physician, and structural levels may be required to increase HCV diagnosis, including prompt detection of HCV reinfection. Timely consideration of these issues is required to maximize the population-level impact of HCV direct-acting antiviral therapy. Potential HCV transmissions from HIV-uninfected GBM, across international borders, and from those who are not GBM also warrant consideration. [ABSTRACT FROM AUTHOR]

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Background: HIV rapid point-of-care (RPOC) testing was approved in Australia in 2012 prompting new testing models. We describe gay, bisexual and other men who have sex with men (GBM) testing in the first year of operations at Australia's first shop-front, community-based RPOC testing service, PRONTO!, and characterise return testers and first-time testers.Methods: Univariable and multivariable logistic regression using data collected at clients' first test at PRONTO! from 15 August 2013 to 14 August 2014 examined correlates of: 1) return-testing within 6 months of GBMs first test at PRONTO!; and 2) reporting a first ever HIV test at PRONTO!.Results: In the first year, 1226 GBM tested at PRONTO! (median age=30.4 years, 60.2% Australian born). Condomless anal sex with casual or regular partners was reported by 45% and 66% of GBM, respectively. Almost one-quarter (23%) of GBM returned within 6 months of their first test. Return-testing was associated with being born overseas (adjusted odds ratio (AOR)=1.48, 95% confidence interval (CI)=1.10-2.0), reporting a regular check-up as reason to test (AOR=1.53, 95% CI=1.01-2.30) and reporting a HIV test in the 6 months before first testing at PRONTO! (AOR=1.73, 95% CI=1.09-2.73). Reporting first testing at PRONTO! (17.9%) was positively associated with younger age (<30 years; AOR=1.78, 95% CI=1.18-2.71) and negatively associated with reporting a regular check-up as reason to test (AOR=0.45, 95% CI=0.29-0.71) and recent group sex (AOR=0.37, 95% CI=0.23-0.59).Conclusion: Despite PRONTO! being designed to reduce barriers to HIV testing, return testing rates in the first year were low and not associated with client risk. Service refinements, including the provision of comprehensive sexually transmissible infection testing, are needed to increase testing frequency and enhance population HIV prevention benefits. [ABSTRACT FROM AUTHOR]

This systematic review and meta-analysis of 58 studies found that antiretroviral therapy is not associated with increased sexual or injecting risk-taking behavior among HIV-infected individuals undergoing treatment.Background. Increased global access and use of antiretroviral therapy (ART) for human immunodeficiency virus (HIV) has been postulated to undermine HIV prevention efforts by changing individual risk-taking behavior. This review aims to determine whether ART use is associated with changes in sexual or injecting risk-taking behavior or diagnosis of sexually transmitted infections (STIs).Methods. A systematic review and meta-analysis was conducted of HIV-seropositive participants receiving ART compared with no ART use in experimental or observational studies. Primary outcomes included (1) any unprotected sexual intercourse, (2) STI diagnoses, and (3) any unsafe injecting behavior.Results. Fifty-eight studies met the selection criteria. Fifty-six studies containing 32 857 participants reported unprotected sex; 11 studies containing 16 138 participants reported STI diagnoses; and 4 studies containing 1600 participants reported unsafe injecting behavior. All included studies were observational. Unprotected sex was lower in participants receiving ART than in those not receiving ART (odds ratio [OR], 0.73; 95% confidence interval [CI], .64–.83; P < .001; heterogeneity I2 = 79%) in both high-income (n = 38) and low-/middle-income country (n = 18) settings, without any evidence of publication bias. STI diagnoses were also lower among individuals on ART (OR, 0.58; 95% CI, .33–1.01; P = .053; I2 = 92%); however, there was no difference in injecting risk-taking behavior with antiretroviral use (OR, 0.90; 95% CI, .60–1.35; P = .6; I2 = 0%).Conclusions. Despite concerns that use of ART might increase sexual or injecting risk-taking, available research suggests that unprotected sex is reduced among HIV-infected individuals on treatment. The reasons for this are not yet clear, although self-selection and mutually reinforcing effects of HIV treatment and prevention messages among people on ART are likely. [ABSTRACT FROM PUBLISHER]

The article describes a 10-year trend in newly acquired HIV notifications in Victoria, Australia and examines recent trends in HIV testing and incidence and risk behaviours among gay and other men who had sex with men (MSM). It notes an increase in notified diagnoses of HIV despite Australia's successful response to the HIV epidemic in the 1980s and 1990s. It points out that 67% of all new HIV diagnoses and 86% of newly acquired HIV infections diagnosed in Australia were due to male-to-male sexual contact among gay and other men having sex with men. It indicates recent increases in the number and proportion of HIV infections classified as newly acquired in Victoria and suggests that increased testing among MSM may contribute to the change.

Undiagnosed HIV infections contribute disproportionately to the HIV epidemic. We recruited 639 gay men attending social venues, who completed a cross-sectional survey with oral fluid collection for HIV testing in 2008. We calculated HIV and undiagnosed HIV prevalence and used χ2 tests and logistic regression to examine associations between participant characteristics and HIV status. Among 639 men, 61 (9.5%, 95% confidence interval: 7.4% to 12.1%) tested HIV positive, of which 19 (31.1%, 95%confidence interval: 19.9% to 44.3%) were classified as undiagnosed HIV positive. Almost a third of HIV-positive men were unaware of their HIV status, and of these men, a large proportion engaged in high-risk behaviors. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to assess self-reported screening practice in the antenatal setting, factors associated with screening, barriers to universal testing for HIV and follow-up for infants born to hepatitis C virus (HCV)-infected women. Methods: A total of 3100 general practitioners (GPs) were mailed the survey. The half from Victoria was randomised to receive their questionnaire by registered post or regular post. All GPs from New South Wales (NSW) received their questionnaire via regular post. Results: The overall response rate was 70%. Registered post resulted in a higher cumulative response rate compared with regular post (86% vs. 67% P < 0.001). Greater than 90% of respondents always screened for syphilis, rubella and hepatitis B virus. Testing for HIV and HCV approached 66% in NSW. In Victoria more respondents always screen for HCV (72%) compared with HIV-1 (64%). Respondents from NSW were less likely to screen for toxoplasmosis (adjusted odds ratio (AOR) 0.64 (0.43, 0.94) P = 0.02) or HCV (AOR 0.75 (0.61, 0.92) P = 0.005) compared with Victoria. Older respondents were more likely to screen for toxoplasmosis (AOR 1.54 (1.05, 2.27) P = 0.03), cytomegalovirus (OR 1.5 (1.0, 2.1) P = 0.05) and chlamydia (AOR 1.88 (1.27, 2.77) P = 0.002). Of respondents who have managed a pregnant woman with HCV 25% inappropriately test infants for infection before one month of age. Conclusion: This study highlights the need for more education and resources to increase HIV testing rates and to improve follow-up of an HCV-exposed infant. [ABSTRACT FROM AUTHOR]

Abstract: This paper outlines a commentary response to an article published by Young and colleagues in Preventive Medicine that evaluated the feasibility of using Twitter as a surveillance and monitoring took for HIV. We draw upon the broader literature on disease surveillance and public health prevention using social media and broader considerations of epidemiological and surveillance methods to provide readers with necessary considerations for using social media in epidemiology and surveillance. [Copyright &y& Elsevier]

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]