Effective strategies to promote HIV self-testing for men who have sex with men: Evidence from a mathematical model

Background: HIV testing is the gateway to HIV treatment and prevention. HIV self-testing (HIVST) has potential to increase testing; however, the potential population-level impact of HIVST on the HIV epidemic and the best strategies for promoting HIVST are unknown. Our aim is to inform public health...

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Autores principales:	Deven T. Hamilton, David A. Katz, Wei Luo, Joanne D. Stekler, Eli S. Rosenberg, Patrick S. Sullivan, Steven M. Goodreau, Susan Cassels
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	Network modeling HIV transmission dynamics HIV self-testing Infectious and parasitic diseases RC109-216
Acceso en línea:	https://doaj.org/article/c58d86984c8142778719cd99c3626b9d
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spelling	oai:doaj.org-article:c58d86984c8142778719cd99c3626b9d2021-11-12T04:28:37ZEffective strategies to promote HIV self-testing for men who have sex with men: Evidence from a mathematical model1755-436510.1016/j.epidem.2021.100518https://doaj.org/article/c58d86984c8142778719cd99c3626b9d2021-12-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S1755436521000645https://doaj.org/toc/1755-4365Background: HIV testing is the gateway to HIV treatment and prevention. HIV self-testing (HIVST) has potential to increase testing; however, the potential population-level impact of HIVST on the HIV epidemic and the best strategies for promoting HIVST are unknown. Our aim is to inform public health approaches for promoting HIVST as part of a comprehensive strategy to reduce HIV incidence. Methods: Stochastic network-based HIV transmission models were used to estimate how different HIVST strategies would affect HIV incidence in Seattle and Atlanta over 10 years. We included four types of HIV testers and implemented nine replacement and eleven supplementation strategies for HIVST. Results: Replacement of clinic-based tests with HIVST increased HIV incidence in Seattle and Atlanta. The benefits of supplementary strategies depended on the tester type using HIVST. Targeting non-testers averted the highest number of cases per test. In Seattle 2.2 (95%SI=−77, 100.4) and 4.7 (95%SI=−35.7, 60.1) infections were averted per 1000 HIVST when non-testers used HIVST once or twice per year respectively. In Atlanta the comparable rates were 8.0 (95%SI=−60.3 to 77.7) and 6.7 (95%SI=−37.7, 41.0). Paradoxically, increasing testing among risk-based testers using HIVST increased incidence. Conclusions: The population-level impact of HIVST depends on who is reached with HIVST, how kits are used, and by characteristics of the underlying epidemic and HIV care infrastructure. Targeted HIVST can be an effective component of a comprehensive HIV testing strategy. More work is needed to understand how to identify and target non-testers for self-testing implementation.Deven T. HamiltonDavid A. KatzWei LuoJoanne D. SteklerEli S. RosenbergPatrick S. SullivanSteven M. GoodreauSusan CasselsElsevierarticleNetwork modelingHIV transmission dynamicsHIV self-testingInfectious and parasitic diseasesRC109-216ENEpidemics, Vol 37, Iss , Pp 100518- (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Network modeling HIV transmission dynamics HIV self-testing Infectious and parasitic diseases RC109-216
spellingShingle	Network modeling HIV transmission dynamics HIV self-testing Infectious and parasitic diseases RC109-216 Deven T. Hamilton David A. Katz Wei Luo Joanne D. Stekler Eli S. Rosenberg Patrick S. Sullivan Steven M. Goodreau Susan Cassels Effective strategies to promote HIV self-testing for men who have sex with men: Evidence from a mathematical model
description	Background: HIV testing is the gateway to HIV treatment and prevention. HIV self-testing (HIVST) has potential to increase testing; however, the potential population-level impact of HIVST on the HIV epidemic and the best strategies for promoting HIVST are unknown. Our aim is to inform public health approaches for promoting HIVST as part of a comprehensive strategy to reduce HIV incidence. Methods: Stochastic network-based HIV transmission models were used to estimate how different HIVST strategies would affect HIV incidence in Seattle and Atlanta over 10 years. We included four types of HIV testers and implemented nine replacement and eleven supplementation strategies for HIVST. Results: Replacement of clinic-based tests with HIVST increased HIV incidence in Seattle and Atlanta. The benefits of supplementary strategies depended on the tester type using HIVST. Targeting non-testers averted the highest number of cases per test. In Seattle 2.2 (95%SI=−77, 100.4) and 4.7 (95%SI=−35.7, 60.1) infections were averted per 1000 HIVST when non-testers used HIVST once or twice per year respectively. In Atlanta the comparable rates were 8.0 (95%SI=−60.3 to 77.7) and 6.7 (95%SI=−37.7, 41.0). Paradoxically, increasing testing among risk-based testers using HIVST increased incidence. Conclusions: The population-level impact of HIVST depends on who is reached with HIVST, how kits are used, and by characteristics of the underlying epidemic and HIV care infrastructure. Targeted HIVST can be an effective component of a comprehensive HIV testing strategy. More work is needed to understand how to identify and target non-testers for self-testing implementation.
format	article
author	Deven T. Hamilton David A. Katz Wei Luo Joanne D. Stekler Eli S. Rosenberg Patrick S. Sullivan Steven M. Goodreau Susan Cassels
author_facet	Deven T. Hamilton David A. Katz Wei Luo Joanne D. Stekler Eli S. Rosenberg Patrick S. Sullivan Steven M. Goodreau Susan Cassels
author_sort	Deven T. Hamilton
title	Effective strategies to promote HIV self-testing for men who have sex with men: Evidence from a mathematical model
title_short	Effective strategies to promote HIV self-testing for men who have sex with men: Evidence from a mathematical model
title_full	Effective strategies to promote HIV self-testing for men who have sex with men: Evidence from a mathematical model
title_fullStr	Effective strategies to promote HIV self-testing for men who have sex with men: Evidence from a mathematical model
title_full_unstemmed	Effective strategies to promote HIV self-testing for men who have sex with men: Evidence from a mathematical model
title_sort	effective strategies to promote hiv self-testing for men who have sex with men: evidence from a mathematical model
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/c58d86984c8142778719cd99c3626b9d
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Effective strategies to promote HIV self-testing for men who have sex with men: Evidence from a mathematical model

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