title: A 'test and treat' prevention strategy in Australia requires innovative HIV testing models: a cohort study of repeat testing among 'high-risk' men who have sex with men.
abstract: HIV diagnoses among men who have sex with men (MSM) in several high-income countries, including Australia, have increased substantially over recent years. Australia, in line with global prevention strategies, has emphasised a 'test and treat' HIV prevention strategy which relies on timely detection of HIV through frequent testing by those at risk. We examined trends in repeat testing among MSM defined as 'high-risk' according to Australian testing guidelines.
  
  
  
  HIV test records from MSM attending high caseload clinics in Melbourne 2007-2013 and classified as high-risk were analysed. Binary outcomes of 'test within 3 months' and 'test within 6 months' were assigned to tests within individuals' panel of records. Negative binomial regressions assessed trends in overall HIV testing and returning within 3 and 6 months. Annualised proportions of return tests (2007-2012) were compared using two-sample z tests.
  
  
  
  Across 18 538 tests among 7117 high-risk MSM attending primary care clinics in Melbourne (2007-2013), the number of annual HIV tests increased (p<0.01). Between 2007 and 2012 annualised proportions of tests with a subsequent test within 3 and 6 months also increased (p<0.01); however, by 2012 only 36.4% and 15.1% of tests were followed by another test inside 6 and 3 months, respectively.
  
  
  
  Repeat testing among high-risk MSM in Australia remains unacceptably low, with recent modest increases in testing unlikely to deliver meaningful prevention impact. Removing known barriers to HIV testing is needed to maximise the potential benefit of test and treat-based HIV prevention.
authors.affiliation: Centre for Population Health, Burnet Institute, Melbourne, Victoria, Australia School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: Anna L
authors.initials: AL
authors.lastname: Wilkinson
authors.affiliation: Centre for Population Health, Burnet Institute, Melbourne, Victoria, Australia.
authors.forename: Carol
authors.initials: C
authors.lastname: El-Hayek
authors.affiliation: Centre for Population Health, Burnet Institute, Melbourne, Victoria, Australia.
authors.forename: Tim
authors.initials: T
authors.lastname: Spelman
authors.affiliation: Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia Central Clinical School, Monash University, Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: Christopher K
authors.initials: CK
authors.lastname: Fairley
authors.affiliation: Victorian Infectious Disease Reference Laboratory, Melbourne, Victoria, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Leslie
authors.affiliation: Centre for Population Health, Burnet Institute, Melbourne, Victoria, Australia Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.
authors.forename: Emma S
authors.initials: ES
authors.lastname: McBryde
authors.affiliation: Centre for Population Health, Burnet Institute, Melbourne, Victoria, Australia School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, Victoria, Australia Department of Infectious Disease, Alfred Health, Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: Margaret
authors.initials: M
authors.lastname: Hellard
authors.affiliation: Centre for Population Health, Burnet Institute, Melbourne, Victoria, Australia School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Stoové
mesh_terms: D001315:Australia / Q000453:epidemiology; D015331:Cohort Studies; D042241:Early Diagnosis; D015658:HIV Infections / Q000175:diagnosis* / Q000517:prevention & control* / Q000523:psychology; D015438:Health Behavior; D018451:Homosexuality, Male / Q000523:psychology; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D010342:Patient Acceptance of Health Care; D012309:Risk-Taking; D018571:Sentinel Surveillance; D012747:Sexual Partners / Q000523:psychology; D047568:Unsafe Sex / Q000706:statistics & numerical data*
keywords: HIV TESTING; MEN; PREVENTION; SEXUAL BEHAVIOUR