The Effects of HIV Self-testing on HIV Incidence and Awareness of Status Among Men Who Have Sex With Men in the United States: Insights From a Novel Compartmental Model.

Details

• Alternative Title:
  Epidemics, 2024, v. 49: The Effects of HIV Self-testing on HIV Incidence and Awareness of Status Among Men Who Have Sex With Men in the United States: Insights From a Novel Compartmental Model.
• Journal Article:
  Epidemics
• Personal Author:
  Viguerie, Alex ; Gopalappa, Chaitra ; Lyles, Cynthia M. ; Farnham, Paul G.
• Description:
  The OraQuick In-Home HIV self-test represents a fast, inexpensive, and convenient method for users to assess their HIV status. If integrated thoughtfully into existing testing practices, accompanied by efficient pathways to formal diagnosis, self-testing could enhance both HIV awareness and reduce HIV incidence. However, currently available self-tests are less sensitive, particularly for recent infection, when compared to gold-standard laboratory tests. It is important to understand the impact if some portion of standard testing is replaced by self-tests. We used a compartmental model to evaluate the effects of self-testing in diverse scenarios among gay, bisexual and other men who have sex with men (MSM) in the United States for the period 2020-2030, and to understand which scenarios maximize the advantages of self-testing.
  
  We introduced a novel 4-compartment model for HIV self-testing. We employed the model under different screening rates, self-test proportions, and delays to diagnosis for those identified through self-tests to determine the potential effects of self-testing on HIV incidence and awareness of status when applied to the US MSM population. We studied scenarios in which self-tests supplement laboratory-based tests, with no replacement, and scenarios in which some replacement occurs. We also examined how future improvements in self-test sensitivity may affect our results.
  
  When HIV self-tests are supplemental rather than substitutes for laboratory-based testing, self-testing can decrease HIV incidence among MSM in the US by up to 10 % and increase awareness of status among MSM from 85 % to 91 % over a 10-year period, provided linkage to care and formal diagnosis occur promptly following a positive self-test (90 days or less). As self-tests replace a higher percentage laboratory-based testing algorithms, increases in overall testing rates were necessary to ensure reductions in HIV incidence. However, such needed increases were relatively small (under 10 % for prompt engagement in care and moderate levels of replacement). Improvements in self-test sensitivity and/or decreases in the detection period may further reduce any necessary increases in overall testing by up to 40 %.
  
  If properly utilized, self-testing can provide significant long-term reductions to HIV incidence and improve awareness of HIV status. Ensuring that self-testing increases overall testing and that formal diagnosis and engagement in care occur promptly following a positive self-test are necessary to maximize the benefits of self-testing. Future improvements in self-test sensitivity and reductions in the detection period would further reduce HIV incidence and the potential risks associated with replacing laboratory tests with self-tests.
• Content Notes:
  Author manuscript
• Subjects:
  • Humans
  • Male
  • HIV Infections
  • Homosexuality, Male
  • Incidence
  • Self-Testing
  • Adult
  • HIV Testing
  • Mass Screening
  • Sexual and Gender Minorities
• Keywords:
  • HIV
  • HIV/AIDS
  • self-testing
  • mathematical modeling
• Source:
  Epidemics, 2024, v. 49
• DOI:
  https://doi.org/10.1016/j.epidem.2024.100796
• ISSN:
  1755-4365 ; 1878-0067
• Pubmed ID:
  39369490
• Pubmed Central ID:
  PMC11912561
• Document Type:
  Text
• Funding:
  CC999999/ImCDC/Intramural CDC HHSUnited States/
• Genre:
  Journal Article
• Place as Subject:
  United States
• Pages in Document:
  100796 (39 pdf pages)
• Volume:
  49
• Download URL:
  https://stacks.cdc.gov/view/cdc/261994/cdc_261994_DS1.pdf
• File Type:
  [PDF - 1.73 MB]
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:ca4d39e8fadd9e1ef96ec18e23e5d959dc265751e7cc18998f139e863ebd34481fd804ae48c45d265e96d4a9e90b3e9ef8dd307687d2aa0c13044225086f0cff