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

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.