Optimizing Human Immunodeficiency Virus Testing Interventions for Men Who Have Sex With Men in the United States: A Modeling Study.

Abstract

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.