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HIV testing intervention development among men who have sex with men in the developed world

Paul Flowers A D , Claudia Estcourt A , Pam Sonnenberg B and Fiona Burns B C
+ Author Affiliations
- Author Affiliations

A Institute for Applied Health Research, Glasgow Caledonian University, Scotland G4 OBA, UK.

B Research Department of Infection and Population Health, University College London, WC1E 6JB, UK.

C Royal Free London NHS Foundation Trust, NW3 2QG, UK.

D Corresponding author. Email: P.Flowers@gcu.ac.uk

Sexual Health 14(1) 80-88 https://doi.org/10.1071/SH16081
Submitted: 15 May 2016  Accepted: 19 October 2016   Published: 13 January 2017

Abstract

HIV testing is a ‘gateway’ technology, enabling access to treatment and HIV prevention. Biomedical approaches to prevention, such as pre-exposure prophylaxis and treatment as prevention, require accurate and regular HIV test results. HIV testing also represents a powerful ‘teachable moment’ for behavioural prevention. An increasing range of HIV tests and the emergence of self-managed diagnostic technologies (e.g. self-testing) means there is now considerable diversification of when, where and how results are available to those who test. These changes have profound implications for intervention development and, indeed, health service redesign. This paper highlights the need for better ways of conceptualising testing in order to capitalise on the health benefits that diverse HIV testing interventions will bring. A multidimensional framework is proposed to capture ongoing developments in HIV testing among men who have sex with men and focus on the intersection of: (1) the growing variety of HIV testing technologies and the associated diversification of their pathways into care; (2) psychosocial insights into the behavioural domain of HIV testing; and (3) better appreciation of population factors associated with heterogeneity and concomitant inequities. By considering these three aspects of HIV testing in parallel, it is possible to identify gaps, limitations and opportunities in future HIV testing-related interventions. Moreover, it is possible to explore and map how diverse interventions may work together having additive effects. Only a holistic and dynamic framework that captures the increasing complexity of HIV testing is fit for purpose to deliver the maximum public health benefit of HIV testing.


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