A study has found that HIV screening every three months compared to annually will improve clinical outcomes and be cost-effective among high-risk young men who have sex with men (YMSM). The report, led by researchers at the Massachusetts General Hospital (MGH), is published in Clinical Infectious Diseases.
Young men who have sex with men account for the biggest chunk of those who get infected with HIV every year.
In the Philippines, for instance, data from the Department of Health in 2019 showed that from October to December 2019, 926 (31%) cases were among youth 15-24 years old and 94% were male. Almost all were infected through sexual contact (89 male-female sex, 597 male-male sex, 233 sex with both males and females).
In the US, one in five new HIV infections is YMSM, and “yet more than half of young men who have sex with men and who are living with HIV don’t even know that they have it,” says Anne Neilan, MD, MPH, investigator in the MGH Division of Infectious Diseases and the Medical Practice Evaluation Center, who led the study. “With so many youth with HIV being unaware of their status, this is an area where there are opportunities not only to improve care for individual youth but also to curb the HIV epidemic…”
Despite these numbers, the Centers for Disease Control and Prevention previously determined that there was insufficient youth-specific evidence to warrant changing their 2006 recommendation of an annual HIV screening among men who have sex with men (MSM).
HIV screening refers to testing of individuals who do not have symptoms of the infection. As defined by the study, high-risk refers to a recent history of condomless anal intercourse, sexually transmitted infection, or multiple sexual partners. Given the disproportionate impact of the HIV epidemic on YMSM, screening for HIV more frequently than current recommendations could identify infections that would otherwise be missed.
HIV screening every three months, in addition to existing patterns of HIV screening among YMSM, would most improve HIV transmission and life expectancy among these men while remaining cost-effective. However, the results do not apply to youth who do not meet high-risk criteria.
The study used data from the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) on how often HIV occurs in each age group, as well as the stage of disease at the time of diagnosis, to project the probable results of screening every three months, six months, or yearly.
Because a traditional study design to examine how often young men who have sex with men should be screened would be nearly impossible to conduct, the authors used a well-published computer microsimulation model developed by members of the research team.
The analysis revealed that HIV screening every three months, in addition to existing patterns of HIV screening among YMSM, would most improve HIV transmission and life expectancy among these men while remaining cost-effective. However, the results do not apply to youth who do not meet high-risk criteria.
Andrea Ciaranello, MD, MPH, investigator MGH Division of Infectious Disease, senior author of the study, says: “The improvements in life expectancy and reduction in HIV transmission were substantial. With more frequent screening, we also estimated that there would be additional, important improvements in the proportion of YMSM who are able to engage in HIV treatment and have excellent control of their HIV infection.”
The authors also highlighted the opportunities for improved implementation of current annual screening recommendations. “If even the current CDC recommendations for annual HIV screening among YMSM could be fully met, important gains could be made both for the health of youth with HIV and in working toward our goal of ending the HIV epidemic,” says Ciaranello. “Ultimately, our study underscores the value of ongoing research to examine the most effective ways to increase HIV screening among youth.”
Neilan adds: “We found that screening every three months was cost-effective.”
In the US, the screening program itself cost up to $760 per person screened. The test itself cost $38-76;.
“This suggests that a large additional investment in innovative HIV screening approaches for youth, including venue-based screening or mobile screening units, would be of good value,” Neilan ends.
Neilan is also an Instructor in Medicine, and Ciaranello is an associate pdrofessor of Medicine at Harvard Medical School.
Additional co-authors of the report are Alexander J. B. Bulteel, Julia H. A. Foote, Kenneth A. Freedberg, MD, MSc, Rochelle P. Walensky, MD, MPH, Pooyan Kazemian, PhD, MGH Medical Practice Evaluation Center; Sybil G. Hosek, PhD, Stroger Hospital of Cook County; Raphael J. Landovitz, MD, MSc, University of California, Los Angeles; Stephen C. Resch, PhD, MPH, Milton C. Weinstein, PhD, Department of Health Policy and Management, Harvard T. H. Chan School of Public Health; A. David Paltiel, PhD, MBA, Yale School of Public Health; and Craig M. Wilson, MD, Department of Epidemiology, University of Alabama at Birmingham School of Public Health.