HIV is a significant issue in Australia but elimination is possible. In Australia, nearly 1000 people are infected with HIV every year, with a lifetime cost of $1.1 million dollars per newly infected person.(1) There is hope that HIV elimination is possible with reports of declining incidence in Australia, London, and San Francisco.(2-4.
There are inequities in our HIV response. Like many high-income countries, HIV in Australia is largely concentrated in men who have sex with men (MSM). Australian born MSM have reduced HIV incidence since 2014 but we are not seeing the same declines in HIV incidence among overseas born MSM. HIV elimination is possible if HIV prevention is available to all MSM. HIV transmission can be essentially prevented if MSM are tested frequently and new infections are rapidly treated so they become non-infectious (termed Treatment as Prevention, TasP)(5) and HIV-negative MSM take daily HIV preventive treatment called pre-exposure prophylaxis (PrEP) to stay HIV-negative.(6) If these powerful interventions are not implemented broadly (i.e. including overseas born MSM) then they will fail.
1) Systematic literature review to understand decision-making for HIV testing and access to HIV prevention among overseas born MSM
2) Crowdsourcing challenge contest to enhance HIV prevention among overseas born MSM
3) Discrete choice experiments to determine preferences for the crowdsourced solution among overseas born MSM
4) Clinical trial and economic evaluation
1. Gray R. Email communication (estimates based on modelling) October 14th 2019. Kirby Institute, University of New South Wales.
2. University of New South Wales. HIV, viral hepatitis and sexually transmitted infections in Australia: Annual Surveillance Report 2018 [Available from: https://kirby.unsw.edu.au/report-type/annual-surveillance-reports.
3. Nwokolo N, Hill A, McOwan A, Pozniak A. Rapidly declining HIV infection in MSM in central London. Lancet HIV. 2017;4(11):e482-e3.
4. Scheer S, Hsu L, Schwarcz S, Pipkin S, Havlir D, Buchbinder S, et al. Trends in the San Francisco Human Immunodeficiency Virus Epidemic in the "Getting to Zero" Era. Clin Infect Dis. 2018;66(7):1027-34.
5. Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365(6):493-505.
6. Grant RM, Lama JR, Anderson PL, McMahan V, Liu AY, Vargas L, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010;363(27):2587-99.
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