Funding antiretroviral treatment for HIV-positive temporary residents in Australia prevents transmission and is inexpensive

Gray, Richard T.; Watson, Jo; Cogle, Aaron; Smith, Don; Hoy, Jennifer; Bastian, Lisa; Finlayson, Robert; Drummond, Fraser; Whittaker, Bill; Law, Matthew; Petoumenos, Kathy

doi:10.1071/sh16237

Cited by 5 publications

(11 citation statements)

References 19 publications

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“…Unlike Australian-born GBMSM and men from RHCA countries, the cost of an HIV test was the most important attribute for GBMSM from non-RHCA countries. This finding is consistent with previous studies that find that promoting free or reduced-cost HIV services among undertested people who have constrained access to healthcare improves their engagement in the HIV cascade ( 23 , 53 – 56 ). In Australia, free HIV testing services are available through state government-funded sexual health centres and community-based health services, regardless of their Medicare status ( 21 , 22 ).…”

Section: Discussionsupporting

confidence: 92%

Preferences for HIV Testing Services and HIV Self-Testing Distribution Among Migrant Gay, Bisexual, and Other Men Who Have Sex With Men in Australia

et al. 2022

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BackgroundIn Australia, undiagnosed HIV rates are much higher among migrant gay, bisexual, or other men who have sex with men (GBMSM) than Australian-born GBMSM. HIV self-testing is a promising tool to overcome barriers to HIV testing and improve HIV testing uptake among migrant GBMSM. We compared the preferences for HIV testing services, including HIV self-testing, among migrant and Australian-born GBMSM.MethodsPreferences were assessed via two discrete choice experiments (DCEs). Participants were recruited between December 2017 and January 2018 using online and offline advertising and randomly assigned to complete one of two online DCE surveys. Migrant GBMSM were classified as being born in a country with a reciprocal healthcare agreement (RHCA) with Australia (providing free or subsided health care) or not. Latent class analysis and mixed logit models were used to explore heterogeneity in preferences.FindingsWe recruited 1,606 GBMSM, including 583 migrant men of whom 419 (72%) were born in non-RHCA countries. Most participants preferred a free or cheap oral test with higher accuracy and a shorter window period to facilitate early detection of infections. Cost was more important for men born in non-RHCA countries than for men from RHCA countries or Australia. All groups preferred accessing kits through online distributers or off the shelf purchasing from pharmacies. Men born in RHCA countries least preferred accessing HIV self-testing kits from a medical clinic, while more than half of men from non-RHCA countries most preferred sourcing kits from a clinic. Sex-on-premises venues were the least preferred location to access test kits among all groups. In addition, two latent class analyses explored heterogeneity in preferences among men from non-RHCA countries and we found four latent classes for HIV testing services and two latent classes for HIVST distribution.InterpretationOur findings emphasise the need for high-performing and low-cost HIV self-testing kits that are accessible from a variety of distribution points as a component of Australia's HIV response, especially for those who do not have access to free or subsidised health care in Australia.

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Section: Discussionsupporting

confidence: 92%

Preferences for HIV Testing Services and HIV Self-Testing Distribution Among Migrant Gay, Bisexual, and Other Men Who Have Sex With Men in Australia

et al. 2022

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“…A study that compared documented and undocumented migrants in Italy found that despite free access to ART, migrants still had difficulties in gaining optimal HIV care [34]. In contrast, other studies found that when healthcare cost barriers are removed for migrants living with HIV, VS increases, thereby reducing risk of transmission [36,37]. Removing barriers that migrants living with or at risk of HIV face is expected to improve health outcomes and progress toward the UNAIDS Fast-Track targets.…”

Section: Discussionmentioning

confidence: 99%

Gaps in the HIV diagnosis and care cascade for migrants in Australia, 2013–2017: A cross-sectional study

et al. 2020

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Background Globally, few studies compare progress toward the Joint United Nations Program on HIV/ AIDS (UNAIDS) Fast-Track targets among migrant populations. Fast-Track targets are aligned to the HIV diagnosis and care cascade and entail achieving 90-90-90 (90% of people living with HIV [PLHIV] diagnosed, 90% of those diagnosed on treatment, and 90% of those on treatment with viral suppression [VS]) by 2020 and 95-95-95 by 2030. We compared cascades between migrant and nonmigrant populations in Australia. Methods and findings We conducted a serial cross-sectional survey for HIV diagnosis and care cascades using modelling estimates for proportions diagnosed combined with a clinical database for proportions on treatment and VS between 2013-2017. We estimated the number of PLHIV and number diagnosed using New South Wales (NSW) and Victorian (VIC) data from the Australian National HIV Registry. Cascades were stratified by migration status, sex, HIV exposure, and eligibility for subsidised healthcare in Australia (reciprocal healthcare agreement [RHCA]). We found that in 2017, 17,760 PLHIV were estimated in NSW and VIC, and 90% of them were males. In total, 90% of estimated PLHIV were diagnosed. Of the 9,391 who were diagnosed and retained in care, most (85%; n = 8,015) were males. We excluded 38% of PLHIV with missing data for country of birth, and 41% (n = 2,408) of eligible retained PLHIV were migrants. Most migrants were from Southeast Asia (SEA; 28%), northern Europe (12%), and eastern Asia (11%). Most of the migrants and nonmigrants were males (72% and 83%, respectively). We found that among those retained in care, 90% were on antiretroviral therapy (ART), and 95% of those on ART had VS (i.e., 90-90-95). Migrants had larger gaps in their HIV diagnosis and care cascade (85-85-93) compared with

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“…Data from the Australian National HIV Registry showed that 19,099 people had been diagnosed in NSW to 31 December 2016. The ABS estimated that 0.44% of NSW residents emigrated overseas in 2016 . In follow‐up of people diagnosed with HIV, 50 (4.8%) of 1043 NSW residents newly diagnosed with HIV from 2013 to 2015 had emigrated in the first six months following diagnosis.…”

Section: Resultsmentioning

confidence: 99%

“…There were 8315 NSW residents who received subsidized ART through the PBS in 2016. Among Australian temporary residents living with HIV we assumed that the 2014 data were unchanged in 2016 and that they applied to NSW and estimated that there were 172 (range 151 to 201) temporary residents on ART in NSW in 2016 .…”

Section: Resultsmentioning

confidence: 99%

“…First, directly collected information on emigration from NSW and Australia were only available for HIV diagnoses from 2013, and only for the first six months after diagnosis and we assumed that longer term migration rates for PLDHIV were the same as general population rates. Second, we assumed that the proportion of PLDHIV who are ineligible for subsidized ART had not changed since 2014, and that the NSW proportion was the same as the Australia‐wide estimate . Third, it is possible that viral load suppression rates may be different among a small proportion of PLHIV who are not attending the ACCESS clinics or the additional large clinic we contacted.…”

Section: Discussionmentioning

confidence: 99%

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The 2016 HIV diagnosis and care cascade in New South Wales, Australia: meeting the UNAIDS 90‐90‐90 targets

et al. 2018

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IntroductionThe HIV Strategy in New South Wales (NSW) Australia aims to virtually eliminate HIV transmission by 2020. We estimated the 2016 HIV diagnosis and care cascade for the state of NSW, with a focus on introducing population‐based data to improve data quality and assess progress towards the UNAIDS 90‐90‐90 targets.MethodsTo estimate the number of people living with diagnosed HIV (PLDHIV) we used NSW data from the Australian National HIV Registry, enhanced by surveillance among people recently diagnosed with HIV to improve migration estimates. The number of undiagnosed PLHIV was estimated using back‐projection modelling by CD4 count at diagnosis. De‐duplicated prescription claims data were obtained from the Australian Pharmaceutical Benefits Scheme (PBS), and were combined with an estimate for those ineligible, to determine the number of PLDHIV on antiretroviral therapy (ART). Data from a clinic network with 87% coverage of PLDHIV in NSW enabled the estimation of the number on ART who had HIV suppression.Results and discussionWe estimated that 10,110 PLHIV resided in NSW in 2016 (range 8400 to 11,720), among whom 9230 (91.3%) were diagnosed, and 8490 (92.0% of those diagnosed) were receiving ART. Among PLDHIV receiving ART, 8020 (94.5%) had suppressed viral load (<200 HIV‐1 RNA copies/mL). Overall, 79.3% of all PLHIV had HIV virological suppression.Conclusion NSW has met each of the UNAIDS 90‐90‐90 targets. The enhanced surveillance methods and data collection systems improved data quality. Measuring and meeting the 90‐90‐90 targets is feasible and could be achieved in comparable parts of the world.

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Funding antiretroviral treatment for HIV-positive temporary residents in Australia prevents transmission and is inexpensive

Cited by 5 publications

References 19 publications

Preferences for HIV Testing Services and HIV Self-Testing Distribution Among Migrant Gay, Bisexual, and Other Men Who Have Sex With Men in Australia

Preferences for HIV Testing Services and HIV Self-Testing Distribution Among Migrant Gay, Bisexual, and Other Men Who Have Sex With Men in Australia

Gaps in the HIV diagnosis and care cascade for migrants in Australia, 2013–2017: A cross-sectional study

The 2016 HIV diagnosis and care cascade in New South Wales, Australia: meeting the UNAIDS 90‐90‐90 targets

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