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Background: After a decade of a treatment as prevention (TasP) strategy basedon progressive HIV testing scale-up and earlier treatment, a reduction in theestimated number of new infections in men-who-have-sex-with-men (MSM) inEngland had yet to be identified by 2010. To achieve internationally agreedtargets for HIV control and elimination, test-and-treat prevention efforts havebeen dramatically intensified over the period 2010-2015, and, from 2016,further strengthened by pre-exposure prophylaxis (PrEP).  Methods: Application of a novel age-stratified back-calculation approach todata on new HIV diagnoses and CD4 count-at-diagnosis, enabled age-specificestimation of HIV incidence, undiagnosed infections and mean time-to-diagnosisacross both the 2010-2015 and 2016-2018 periods. Estimated incidence trendswere then extrapolated, to quantify the likelihood of achieving HIV eliminationby 2030.  Findings: A fall in HIV incidence in MSM is estimated to have started in2012/3, eighteen months before the observed fall in new diagnoses. A steepdecrease from 2,770 annual infections (95% credible interval 2.490-3,040) in2013 to 1,740 (1,500-2,010) in 2015 is estimated, followed by steady declinefrom 2016, reaching 854 (441-1,540) infections in 2018. A decline isconsistently estimated in all age groups, with a fall particularly marked inthe 24-35 age group, and slowest in the 45+ group. Comparable declines areestimated in the number of undiagnosed infections.  Interpretation: The peak and subsequent sharp decline in HIV incidenceoccurred prior to the phase-in of PrEP. Definining elimination as a publichealth threat to be < 50 new infections (1.1 infections per 10,000 at risk),40% of incidence projections hit this threshold by 2030. In practice, targetedpolicies will be required, particularly among the 45+y where STIs areincreasing most rapidly.

HIV transmission in men who have sex with men in England: on track for elimination by 2030?