News from the CDC: men who have sex with men should be targeted for high-frequency HIV testing.
Quarterly HIV testing of men who have sex with men (MSM) is cost-effective, but annual tests may be all that injection drug users need, according to a new study.
The findings suggest that clinicians should test for HIV among MSM more frequently than annually since it is cost-effective.
Studies show there is a high incidence of HIV infection among MSM who have annual testing, suggesting that more frequent HIV testing may be warranted. Testing technology has become more sensitive and there is increasing use of less sensitive rapid, point-of-care antibody tests, noted researchers led by Angela B. Hutchinson, PhD, from the CDC.
They assessed the cost-effectiveness of HIV testing of MSM and injection drug users at 3-month and 6-month intervals using fourth-generation and point-of-care rapid tests.
Using cohorts of 10,000 MSM and injection drug users, they developed a mathematical model of HIV transmission to evaluate testing intervals for each population. The model incorporated HIV transmissions averted due to serostatus awareness and viral suppression. The model also included costs for HIV testing and treatment initiation, as well as treatment costs saved from averted transmissions.
Over 1 year, for MSM, both 3-month and 6-month testing were cost effective. The fourth-generation test given every 6 months averted 2.0 HIV transmissions and the rapid test averted 1.75 HIV transmissions. Quarterly testing with a fourth-generation test averted an additional 1.20 transmissions.
“For MSM, HIV testing was cost-saving or cost-effective over a 1-year time period for both 6-month compared to annual testing, and quarterly compared to 6-month testing using either test,” they stated.
Testing injection drug users every 6 months compared to annually averted 0.39 HIV transmissions annually. “Testing injection drug users every 6 months compared to annually was moderately cost-effective over a 1-year time period with a fourth-generation test, while testing with rapid, point-of care tests or quarterly was not cost-effective,” they stated.
In a sensitivity analysis, the results for MSM remained robust, while the results for injection drug users were sensitive to changes in HIV incidence and continuum-of-care parameters.
Cost analyses suggested “additional implementation costs could be incurred for more frequent testing for MSM while remaining cost-effective,” they stated.
The message for clinicians appears to be that MSM with high-risk behaviors should be targeted for high-frequency HIV testing.