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• An increasing majority of HIV transmission in Australia is attributed to undiagnosed HIV, with estimates of the proportion of PLHIV who are diagnosed plateauing.
• Priority populations at risk of HIV, including most GBM, are testing for HIV at lower than recommended frequencies.
• Considerable regulatory, health system and psychosocial barriers to frequent HIV testing persist for those at risk of HIV in Australia. Current HIV testing models will not achieve the level of testing coverage or frequency needed to achieve HIV elimination targets by 2025.
• To support frequent HIV testing and early diagnosis among all populations at risk of HIV, more convenient, accessible and person-centred HIV testing and linkage to care models must be developed, expanded and maintained, including peer-led services and home-based and outreach testing models.
• Access to subsidised HIV and other STI testing should be made available to all people residing in Australia, regardless of visa status.

Establishing measurable targets remains difficult. Reliable measurement of some suggested targets may require strengthening existing surveillance and innovating new measurement approaches, particularly when measuring outcomes in some priority populations, to ensure equity of access to HIV prevention and care responses.

Proposed testing targets required to achieve elimination of HIV transmission in Australia by 2025

1. 95% of PLHIV overall, within priority populations and regardless of country of birth, cultural background, area of residence, gender and age, have been diagnosed by 2025.
2. 90% of all people at risk of acquiring HIV have had an HIV test in the past 12 months by 2025.
3. 95% of all people identified as being at risk of HIV who attend a health service receive an HIV test by 2025.
4. 80% of all GBM at risk of HIV are testing every three months by 2025.

• Make subsidised HIV and other STI testing available to all people residing in Australia, regardless of visa status.
• Map the coverage of existing specialist sexual health and HIV primary care services and develop and fund a strategy to increase the size of the general practice and other clinical workforce specialising in sexual health and the coverage of sexual health services.
• TGA to review the conditions under which HIV self-tests are sold or accessed in Australia (as well as any other regulatory barriers for self-tests on the market), balancing consumer safety against the accessibility and convenience of self-test distribution models and their capacity to increase testing frequency and prevention impact.
• Make Medicare rebates available for POCTs that meet TGA diagnostic standards and DBS HIV testing available, and develop and fund accompanying testing models that allow these technologies to be integrated into suitable care and practice environments.
• Commonwealth and State and Territory governments to work with self-testing manufacturers to develop HIV self-testing distribution models that encourage frequent testing, allow for effective surveillance and connect users to clinical and other services that support their sexual health, including access to timely diagnostic testing and referral to care for those who receive a reactive self-test result.
• Develop and appropriately fund targeted health promotion, community engagement and service responses to increase testing in recently-arrived overseas-born populations at risk of HIV in Australia.
• Undertake consultations and participatory research to explore possible opt-out models of HIV testing.
• Investigate and implement the deployment of near real-time molecular epidemiology to inform the response to HIV clusters.