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Title
HIV prevention in a Fast Track City: Trends in time-dependent HIV cascade indicators among gay and bisexual men attending high HIV caseload testing services in Melbourne, Australia
Presenter
Mark Stoove
Authors
M. Stoove1,2, J. Asselin1, C. El-Hayek1, S. Lewin3,4, B. Allan5, J. Hoy6, E. Wright1,6, S. Ruth7, J. Mills6,8, C. Carter9, M. West10, J. Manwaring10, A. Fischer4, A. Wilkinson1,11, R. Guy12, B. Donovan12, D. Calendar12, N. Higgins10, P. Locke7, N. Roth13, B. Tee14, J. Wilcox15, L. Nguyen1, K. Ryan1,2, M. Hellard1,2,6
Institutions
1Burnet Institute, Disease Elimination Program, Public Health Discipline, Melbourne, Australia, 2Monash University, School of Population health & Preventive Medicine, Melbourne, Australia, 3Peter Doherty Institute for Infection and Immunity, Melbourne, Australia, 4The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Australia, 5International Council Of AIDS Service Organizations, Toronto, Canada, 6The Alfred Hospital and Monash University, Department of Infectious Diseases, Melbourne, Australia, 7Victorian AIDS Council, Melbourne, Australia, 8Burnet Institute, Melbourne, Australia, 9North-West Melbourne Public Health Network, Melbourne, Australia, 10Victoria Department of Health and Human Services, Melbourne, Australia, 11Cancer Council Victoria, Melbourne, Australia, 12Kirby Institute, University of New South Wales, Sydney, Australia, 13Prahran Market Clinic, Melbourne, Australia, 14Centre Clinic, Victorian AIDS Council, Melbourne, Australia, 15Northside Clinic, Melbourne, Australia

Background: The Fast-Track Cities partnership focuses on translating global HIV goals into local strategies, with progress towards 90-90-90 targets used as key indicators. Melbourne is Australia''s only Fast Track City and, alongside Amsterdam, has reported achieving 90-90-90 targets. Sentinel surveillance in Melbourne also enables monitoring of individuals'' progress through the HIV cascade, producing indicators highly sensitive to change. With 78% of HIV diagnoses in Melbourne occurring among gay and bisexual men (GBM), we present trends in HIV testing, diagnosis rates, and time to viral suppression among GBM attending three general practices specialising in GBM health and one GBM peer-led testing service in Melbourne.
Methods: HIV testing data was extracted from patient management systems through the Australian Collaboration for Coordinated Enhanced Sentinel Surveillance (ACCESS) between Jan 2012-Sep 2017. Using anonymised unique identifiers, ACCESS prospectively links data on individuals'' clinic attendances and laboratory test results. We calculated annualised trends in repeat testing (follow-up tests within three, six and 12-months), HIV positivity, the proportion of GBM with undetectable viral loads (<200 copies/ml) within 12 months of diagnosis and median time between diagnosis and undetectable viral load.
Results: 11,607 GBM received 47,722 HIV diagnostic tests between 2012 and 2017. There were significant increases in 12-month (56% to 63%; p<.01), six-month (28% to 44%; p<.001) and three-month (10% to 22%; p<.001) repeat testing. Between 2012 and 2017, 292 GBM were newly diagnosed with HIV; HIV positivity was 1.5% in 2012, peaked at 2.2% in 2014 then declined significantly to 0.4% in 2017 (p<.001). Among GBM newly diagnosed between 2012 and 2016, the percentage with undetectable viral loads (<200 copies/ml) within 12 months of diagnosis increased from 59% to 97% (p<.001) and the median time between diagnosis and undetectable viral load declined from 162 days to 50 days (p<.001).
Conclusions: Considerable declines in time between HIV diagnosis and viral suppression among GBM attending specialist HIV testing services in Melbourne have coincided with substantial declines in HIV diagnosis rates at these services. The most recent declines in diagnoses also coincided with a substantial scale up of PrEP among GBM in 2016-17 as part of a multi-site implementation project.


HIV diagnoses and post-diagnosis viral suppression among GBM attending specialist HIV service in Melbourne, 2012-17
[HIV diagnoses and post-diagnosis viral suppression among GBM attending specialist HIV service in Melbourne, 2012-17]