HIV medicine · 2025
Strategies to achieve the UNAIDS 95% HIV diagnosis target in Australia: Insights from a multidisciplinary roundtable.
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Clifton Brent, Keen Phillip, Trevillyan Janine, Sullivan Nikki, Johnson Karl, Warner Melissa, Taheny Cara, Ellis Heather, Freestone Jack, Allan Brent, Newham Beau
Аннотация
INTRODUCTION: In 2022, Australia met the global UNAIDS 95% targets for treatment and viral suppression. Achieving 95% of people knowing their HIV status requires implementation of a wider mix of HIV testing types and access points.
METHODS: In October 2023, a community-led HIV testing roundtable meeting of 34 participants was convened to better understand current barriers and enablers to foster HIV testing equity. Delegates participated in data-informed discussions and a facilitated workshop. Outputs were collated and independently analysed to identify HIV testing barriers and potential actionable strategies.
RESULTS: Current best practices for HIV testing are targeted towards at-risk populations and limited by funding and capacity constraints. Identified barriers to testing include ongoing stigma, cultural barriers, structural barriers to accessing and navigating the healthcare system, clinical reticence among non-expert practitioners and the need to expand access beyond at-risk groups. Current HIV testing practices are limited by a lack of provider-initiated (opt-out) testing, contributing to late diagnoses among people with high barriers to testing. Awareness of and access to HIV testing resources need to be expanded and should be underpinned by healthcare education. Wider exploration of opt-out testing is warranted, but requires consideration of jurisdictional infrastructure/funding differences and determination of optimal settings.
CONCLUSIONS: To achieve the UNAIDS 95% diagnosis target, we recommend three key strategies: implementing opt-out testing in selected settings, expanding access to self-testing and reducing barriers to point of care testing. These strategies should be supported by enhanced healthcare provider education and actions to reduce structural barriers to testing access.
METHODS: In October 2023, a community-led HIV testing roundtable meeting of 34 participants was convened to better understand current barriers and enablers to foster HIV testing equity. Delegates participated in data-informed discussions and a facilitated workshop. Outputs were collated and independently analysed to identify HIV testing barriers and potential actionable strategies.
RESULTS: Current best practices for HIV testing are targeted towards at-risk populations and limited by funding and capacity constraints. Identified barriers to testing include ongoing stigma, cultural barriers, structural barriers to accessing and navigating the healthcare system, clinical reticence among non-expert practitioners and the need to expand access beyond at-risk groups. Current HIV testing practices are limited by a lack of provider-initiated (opt-out) testing, contributing to late diagnoses among people with high barriers to testing. Awareness of and access to HIV testing resources need to be expanded and should be underpinned by healthcare education. Wider exploration of opt-out testing is warranted, but requires consideration of jurisdictional infrastructure/funding differences and determination of optimal settings.
CONCLUSIONS: To achieve the UNAIDS 95% diagnosis target, we recommend three key strategies: implementing opt-out testing in selected settings, expanding access to self-testing and reducing barriers to point of care testing. These strategies should be supported by enhanced healthcare provider education and actions to reduce structural barriers to testing access.