title: "Seek, Test, Treat" Lessons From Australia: A Study of HIV Testing Patterns From a Cohort of Men Who Have Sex With Men.
abstract: OBJECTIVE
  HIV diagnoses are increasing in Australia, mostly among men who have sex with men (MSM). Similar to many countries, Australia's HIV prevention strategies emphasize a "seek, test, treat" approach including enhancing HIV testing frequency. We describe HIV testing among MSM and correlates of returning for testing within 12 months in the context of new HIV prevention paradigms.
  
  
  METHODS
  Testing and behavioral data (2007-2013) contributed by MSM aged ≥ 16 years were included. Total HIV tests by calendar year and repeat tests within 12 months were described, alongside negative binomial regression for trend. A 2-level mixed-effects logistic regression model examined correlates of testing within 12 months. Median (days) between HIV tests was compared between MSM diagnosed with HIV and persistently HIV-negative MSM.
  
  
  RESULTS
  The study included 46,060 tests from 17,904 MSM. There was an increase in annual tests (P < 0.01), repeat tests within 12 months (P < 0.01), and the proportion of tests within 12 months of an index test (P < 0.01), although only to 53.3% in 2013. Return rates were higher in MSM aged 16-29 years (adjusted odds ratio 1.30, 95% confidence interval: 1.1 to 1.5) and those reporting higher numbers of partners (adjusted odds ratio 3.5, 95% confidence interval: 3.0 to 4.0). Median time between tests among MSM diagnosed with HIV (233 days) was greater than for HIV-negative MSM (189 days) (P = 0.03).
  
  
  CONCLUSIONS
  Although testing has increased, testing frequency among many MSM remains suboptimal. To optimize "seek, test, treat"-based HIV prevention strategies, new approaches to increase testing uptake and early HIV detection among MSM are needed.
authors.affiliation: *Burnet Institute, Victoria, Australia; †Monash University, Victoria, Australia; ‡Melbourne Sexual Health Centre, Victoria, Australia; §The University of Melbourne, Victoria, Australia; and ‖Victoria Infectious Disease Reference Laboratory, Victoria, Australia.
authors.forename: Anna Lee
authors.initials: AL
authors.lastname: Wilkinson
authors.forename: Carol
authors.initials: C
authors.lastname: El-Hayek
authors.forename: Tim
authors.initials: T
authors.lastname: Spelman
authors.forename: Christopher
authors.initials: C
authors.lastname: Fairley
authors.forename: David
authors.initials: D
authors.lastname: Leslie
authors.forename: Emma
authors.initials: E
authors.lastname: McBryde
authors.forename: Margaret
authors.initials: M
authors.lastname: Hellard
authors.forename: Mark
authors.initials: M
authors.lastname: Stoové
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D015658:HIV Infections / Q000175:diagnosis* / Q000517:prevention & control; D015438:Health Behavior; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D016017:Odds Ratio; D055815:Young Adult