Factors associated with testing for HIV and hepatitis C among behaviorally vulnerable men in Germany: a cross-sectional analysis upon enrollment into an observational cohort

Albrecht Stoehr,Klaus Jansen,Carsten Tiemann,Jukka Hartikainen,Christoph D. Spinner,Merlin L. Robb,Trevor A. Crowell,Haoyu Qian,Norbert Brockmeyer,Heiko Jessen,Hendrik Streeck,Christoph Boesecke,Christiane Cordes,Stephan Schneeweiß,Nelson L. Michael,Markus Bickel,Clara Lehmann,Stefan Esser

doi:10.1186/s12981-021-00378-4

Abstract

BackgroundHIV and hepatitis C virus (HCV) have shared routes of transmission among men who have sex with men (MSM). Routine testing facilitates early diagnosis and treatment, thereby preventing morbidity and onward transmission. We evaluated factors associated with HIV and HCV testing in a behaviorally vulnerable cohort of predominantly MSM.MethodsFrom June 2018 through June 2019, the BRAHMS study enrolled adults at ten German outpatient clinics that serve gender and sexual minority populations. Participants completed behavioral questionnaires that captured prior experience with HIV and HCV testing. Multivariable robust Poisson regression was used to evaluate factors potentially associated with testing in the previous 6 months.ResultsAmong 1017 participants with median age 33 (interquartile range 28–39) years, 1001 (98.4%) reported any lifetime history of HIV testing and 787 (77.4%) reported any HCV testing, including 16 (1.6%) known to be living with HCV. Testing within the last 6 months was reported by 921 (90.6%) and 513 (50.4%) for HIV and HCV, respectively. Recent HIV testing was more common among participants with higher education level and recent HCV testing. Recent HCV testing was more common among participants with non-cisgender identity, lifetime history of illicit drug use, hepatitis B immunity or infection, and recent HIV testing.ConclusionPrior testing for HIV was common in this cohort, but interventions are needed to improve HCV risk stratification and access to testing. HIV testing infrastructure can be successfully leveraged to support HCV testing, but differentiated preventive care delivery is needed for some vulnerable populations.

Highlights

For persons living with Human immunodeficiency virus (HIV) unaware of their status, HIV testing is the critical first step toward diagnosis, initiation of antiretroviral therapy (ART), and further HIV care
Study population and lifetime history of testing From June 2018 through June 2019, a total of 1017 participants enrolled with median age 33 years
Recent hepatitis C virus (HCV) testing was more common among participants with non-cisgender identity, lifetime history of illicit drug use, hepatitis B immunity or infection, and recent HIV testing (Table 2)

Summary

Introduction

For persons living with HIV unaware of their status, HIV testing is the critical first step toward diagnosis, initiation of antiretroviral therapy (ART), and further HIV care. Despite partial decreases in HIV incidence among men who have sex with men (MSM) in Germany and other Western European countries in recent years, substantial HIV transmission continues [7,8,9,10,11]. U.S recommendations are similar [13] and add 3-monthly testing for MSM who are prescribed HIV pre-exposure prophylaxis (PrEP) [14]. Despite such recommendations, in 2016, about onesixth of MSM living with HIV in six European countries were undiagnosed and one-third of diagnoses occurred late in the disease course, after CD4 had declined below 350 cells/μL [15]. Routine testing facilitates early diagnosis and treatment, thereby preventing morbidity and onward transmission.

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