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Trends in HIV annual test uptake and retesting among gay and bisexual men and other men who have sex with men in Australia with no evidence of PrEP use between 2013-2021

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BACKGROUND: Frequent HIV testing and timely diagnosis and treatment are key parts of Australia's HIV prevention strategy. Monitoring test frequency and adherence to guidelines that recommend three-monthly testing for sexually active gay and bisexual men and other men who have sex with men (GBM) is complicated by the rapid scale of PrEP, where HIV testing also occurs at recommended three-monthly PrEP visits. Using data from clinics in the ACCESS sentinel network, we examined trends in HIV retesting among HIV-negative GBM with no evidence of PrEP use (GBM-NeverPrEP).
METHODS: HIV testing data were extracted from 29 specialist general practice and sexual health services across Australia. GBM-NoPrEP were classified as having no evidence of a PrEP prescription at any point between 2013-2021. HIV test uptake (individuals tested/individuals attended) and mean number of tests/individuals (among those tested) were calculated per calendar year. Annualised three- and 12-month retesting rate was calculated as the proportion of GBM-NoPrEP whose last HIV test within a calendar year was preceded by at least one test within three and 12 months. To account for impacts of the COVID-19, Poisson regression assessed trends from 2013-2019 and 2019-2021.
RESULTS: Of 88,258 HIV-negative GBM who attended services between 2013-2021, 58,942 (67%) were GBM-NeverPrEP. Between 2013 and 2019, annual HIV test uptake among GBM-NeverPrEP increased from 53% to 64% (p<0.001), and declined to 55% in 2021 (p<0.001). From 2013 to 2019, mean number of tests increased from 1.4 to 1.5 per year (p<0.001), declining to 1.4 in 2021 (p<0.001). Between 2013 and 2019, the proportion of GBM-NeverPrEP retested within three months increased from 16% to 19% (p<0.001) and declined to 16% in 2021 (p<0.001). Between 2013 and 2019, the proportion retested within 12 months increased from 46% to 50% (p<0.001) before declining to 43% in 2021 (p<0.001).
CONCLUSIONS: While there were modest increases in HIV test uptake and retesting rates among GBM who have never used PrEP, an overwhelming majority were not testing at recommended frequencies. Testing frequency was further impacted during the COVID-19 pandemic. A renewed focus on HIV risk and the importance of regular testing in GBM not using PrEP is required.