Modelling the HIV epidemic among MSM in the United Kingdom

Punyacharoensin, Narat; Edmunds, W. John; Angelis, Daniela De; Delpech, Valérie; Hart, Graham; Elford, Jonathan; Brown, Alison E; Gill, Noël; White, Richard G.

doi:10.1097/qad.0000000000000525

Cited by 40 publications

(13 citation statements)

References 30 publications

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“…GBM with undiagnosed HIV are believed to contribute disproportionately to HIV transmission in Australia [ 10 ] and have been estimated to account for the majority of new infections in some high-income countries [ 17 – 19 ]. In the absence of reliable national estimates, we set out to generate a more comprehensive measure of undiagnosed HIV among Australian GBM and to assess the characteristics of those with undiagnosed infection.…”

Section: Introductionmentioning

confidence: 99%

The prevalence and correlates of undiagnosed HIV among Australian gay and bisexual men: results of a national, community‐based, bio‐behavioural survey

Holt

Lea

Asselin

et al. 2015

Journal of the International AIDS Society

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IntroductionGay and bisexual men (GBM) with undiagnosed HIV are believed to contribute disproportionately to HIV transmission in Australia but national prevalence estimates have been lacking.MethodsFrom November 2013 to November 2014, we recruited men at gay venues and events in six Australian states and territories. Of 7291 survey participants, 3071 men also provided an oral fluid sample for testing and decided whether to receive their test results or not. We calculated raw and population-weighted prevalence estimates and identified associations with undiagnosed infection using logistic regression.ResultsOf 3071 participants, 213 men tested HIV-positive (6.9%, 95% confidence interval [CI] 6.0 to 7.8%), of whom 19 (8.9%, 95% CI 5.8 to 13.5%) were previously undiagnosed. After weighting for the size of the gay and bisexual male population in each state or territory, national HIV prevalence was estimated to be 7.2% (95% CI 6.3 to 8.1), of which 9.1% (95% CI 6.0 to 13.6%) were estimated to be undiagnosed. Compared with HIV-negative participants, men with undiagnosed HIV were more likely to report meeting partners at sex venues, using antiretroviral drugs as pre-exposure prophylaxis, condomless anal intercourse with casual partners, using party drugs for sex, injecting drugs and using amyl nitrite, crystal methamphetamine or gamma hydroxybutyrate in the six months prior to the survey.DiscussionThe results indicate that the prevalence of undiagnosed HIV is relatively low among Australian GBM but is higher among men who report riskier sex and drug practices.ConclusionsThe results underline the importance of targeted HIV prevention and frequent testing for men at increased risk of infection.

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Section: Introductionmentioning

confidence: 99%

The prevalence and correlates of undiagnosed HIV among Australian gay and bisexual men: results of a national, community‐based, bio‐behavioural survey

Holt

Lea

Asselin

et al. 2015

Journal of the International AIDS Society

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“…There has been extensive previous modelling of effects of increased testing and/or ART HIV epidemics in MSM [23–26], and some linked cost-effectiveness analyses [27–33]. Generally, models show high levels of support for increased HIV testing in MSM.…”

Section: Discussionmentioning

confidence: 99%

Potential impact on HIV incidence of higher HIV testing rates and earlier antiretroviral therapy initiation in MSM

Phillips

Cambiano

Miners

et al. 2015

Aids

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“…A range of studies have attempted to estimate the proportion of transmission that occurs during primary infection, but a large amount of uncertainty remains [ 4 ], and it is likely that the proportion varies between different settings. We have even less understanding of the contribution to overall transmission of people at different stages of the anti-retroviral therapy (ART) care pathway, and how this will change as treatment coverage increases [ 5 , 6 ]. While ART greatly reduces transmission risk [ 7 ], transmission has been observed to occur from people receiving ART, albeit at a low rate, and it is plausible that the rate of transmission will be higher among people not part of research cohorts [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Improving ART programme retention and viral suppression are key to maximising impact of treatment as prevention – a modelling study

et al. 2017

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BackgroundUNAIDS calls for fewer than 500,000 new HIV infections/year by 2020, with treatment-as-prevention being a key part of their strategy for achieving the target. A better understanding of the contribution to transmission of people at different stages of the care pathway can help focus intervention services at populations where they may have the greatest effect. We investigate this using Uganda as a case study.MethodsAn individual-based HIV/ART model was fitted using history matching. 100 model fits were generated to account for uncertainties in sexual behaviour, HIV epidemiology, and ART coverage up to 2015 in Uganda. A number of different ART scale-up intervention scenarios were simulated between 2016 and 2030. The incidence and proportion of transmission over time from people with primary infection, post-primary ART-naïve infection, and people currently or previously on ART was calculated.ResultsIn all scenarios, the proportion of transmission by ART-naïve people decreases, from 70% (61%–79%) in 2015 to between 23% (15%–40%) and 47% (35%–61%) in 2030. The proportion of transmission by people on ART increases from 7.8% (3.5%–13%) to between 14% (7.0%–24%) and 38% (21%–55%). The proportion of transmission by ART dropouts increases from 22% (15%–33%) to between 31% (23%–43%) and 56% (43%–70%).ConclusionsPeople who are currently or previously on ART are likely to play an increasingly large role in transmission as ART coverage increases in Uganda. Improving retention on ART, and ensuring that people on ART remain virally suppressed, will be key in reducing HIV incidence in Uganda.

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Modelling the HIV epidemic among MSM in the United Kingdom

Cited by 40 publications

References 30 publications

The prevalence and correlates of undiagnosed HIV among Australian gay and bisexual men: results of a national, community‐based, bio‐behavioural survey

The prevalence and correlates of undiagnosed HIV among Australian gay and bisexual men: results of a national, community‐based, bio‐behavioural survey

Potential impact on HIV incidence of higher HIV testing rates and earlier antiretroviral therapy initiation in MSM

Improving ART programme retention and viral suppression are key to maximising impact of treatment as prevention – a modelling study

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