Background. In the United States, public
health recommendations for men who have sex with men (MSM) include testing for
human immunodeficiency virus (HIV) at least annually. We model the impact of
different possible HIV testing policies on HIV incidence in a simulated
population parameterized to represent US MSM.
Methods. We used exponential random graph
models to explore, among MSM, the short-term impact on baseline (under current
HIV testing practices and care linkage) HIV incidence of the following: (1)
increasing frequency of testing; (2) increasing the proportion who ever test;
(3) increasing test sensitivity; (4) increasing the proportion of the diagnosed
population achieving viral suppression; and combinations of 1–4. We simulated
each scenario 20 times and calculated the median and interquartile range of
3-year cumulative incidence of HIV infection.
Results. The only intervention that reduced
HIV incidence on its own was increasing the proportion of the diagnosed
population achieving viral suppression; increasing frequency of testing, the
proportion that ever test or test sensitivity did not appreciably reduce
estimated incidence. However, in an optimal scenario in which viral suppression
improved to 100%, HIV incidence could be reduced by an additional 17% compared
with baseline by increasing testing frequency to every 90 days and test
sensitivity to 22 days postinfection.
Conclusions. Increased frequency, coverage, or
sensitivity of HIV testing among MSM is unlikely to result in reduced HIV
incidence unless men diagnosed through enhanced testing programs are also
engaged in effective HIV care resulting in viral suppression at higher rates
than currently observed.
Below: Population-level impact of
increasing testing frequency on 3-year human immunodeficiency virus (HIV)
incidence in a simulated population of 5250 men who have sex with men in the
United States. Estimates are the median and ranges of total cases of HIV
observed over 20 simulations of each scenario, where the frequency of testing
was set to either the baseline distribution observed in our study population or
the time interval indicated on the x-axis.
Below: Synergistic effects of human
immunodeficiency virus (HIV) testing frequency, test sensitivity, and viral suppression
among the diagnosed population on 3-year HIV incidence across 20 simulations of
a population of 5250 men who have sex with men in the United States. Scenario 1
increased HIV testing frequency to once every 90 days and held the percentage
of the diagnosed population that achieve viral suppression to 43.4% and test
sensitivity to 45 days as in the baseline scenario. Scenario 2 increases the
proportion achieving viral suppression to 100% of the diagnosed population,
while keeping the baseline scenario for testing frequency and test sensitivity.
Scenario 3 increases both viral suppression (to 100% of the diagnosed
population) and test sensitivity (to 22 days), while hold testing frequency to
the baseline distribution. Scenario 4 increases testing frequency to every 90
days and increases viral suppression to 100%, while holding test sensitivity to
45 days. Scenario 5 optimizes all 3 strategies at once, with viral suppression
increased to 100% of the diagnosed population, testing every 90 days, and a test
with a 22-day window period.
Full article at: http://goo.gl/d632L8
By: Kevin P. Delaney,1 Eli S. Rosenberg,1 Michael R. Kramer,1 Lance A. Waller,2 and Patrick S. Sullivan1
1Department of Epidemiology, Laney Graduate
School
2Department of Biostatistics and
Bioinformatics, Rollins School of Public Health, Emory University, Atlanta,
Georgia
Correspondence: Kevin P. Delaney, MPH, PhD, Department of
Epidemiology, Emory University, 1518 Clifton Road NE, Mailstop: 1518-002-4AA
(SPH: Epidemiology), Atlanta, GA 30322 (ude.yrome@naledpk).
More at: https://twitter.com/hiv_insight
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