Abstract and Introduction
Abstract
Objectives In the UK, quarterly HIV testing is recommended for high-risk men who have sex with men (MSM). In this manuscript we determined the risk of being newly diagnosed with HIV in MSM by their HIV testing history, considering both the frequency and periodicity of testing.
Methods Data on HIV incidence in MSM attending a sexual health clinic (SHC) in England in 2013−2014 with testing history (previous 2 years) were obtained from GUMCAD, the national sexually transmitted infection (STI) surveillance system in England. HIV testing patterns among MSM were defined using the frequency and periodicity of testing, based on 3 month intervals, in the year preceding the first attendance during the study period. Cox proportional hazards regression was used to determine the association between HIV testing pattern and time to HIV diagnosis with and without adjustment for demographic confounders. Analyses were stratified by risk stratum, with 'high risk' defined as a history of a bacterial STI in the past year. Adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) are reported.
Results Among the 37 702 HIV-negative MSM attending an SHC in 2013−2014, 1105 (3%) were diagnosed with HIV infection within 1 year of their first attendance. The probability of HIV diagnosis was highest in MSM who were tested quarterly compared with those who were not tested in the past year (aHR 2.51; 95% CI 1.33–4.74); this increased 1.8-fold among high-risk MSM (aHR 4.48; 95% CI 0.97–21.17).
Conclusions The probability of subsequent HIV diagnosis was greatest in high-risk MSM who were tested most frequently. Quarterly HIV testing increased the likelihood of identifying undiagnosed HIV infection and should remain a continued recommendation for high-risk MSM.
Introduction
In England, men who have sex with men (MSM) are at highest risk of HIV acquisition[1] The National Institute for Health and Care Excellence (NICE) recommends at least annual HIV screening in MSM, with more frequent testing in those at greater risk of exposure[2] Since 2012, MSM engaging in condomless sex with new or casual partners have been encouraged to be tested every 3 months[3] Quarterly testing recommendations have been extended to MSM disclosing drug use and in those with a newly diagnosed sexually transmitted infection (STI), both seen as proxies for high-risk sexual behaviour.[4]
Recent behavioural data suggest that annual testing guidelines are unlikely to be met and a little over a quarter of MSM engaging in condomless anal intercourse reported testing at least four times in a year[5] Despite modelling studies suggesting cost-effectiveness of quarterly testing for high-risk MSM[6,7] there are limited UK observational studies that have evaluated testing frequency and HIV risk in high-risk MSM[8] Test periodicity (i.e. testing at regular intervals) was not incorporated in test frequency measurements used in previous analyses, despite recommendations for quarterly testing[9,10] In addition, repeat testing and test recency were found to be associated with an increase in behavioural risk of HIV acquisition.[11,12]
With these evidence gaps in mind, this analysis utilized longitudinal surveillance data to assess the probability of HIV diagnosis in MSM by HIV testing history, considering both the frequency and periodicity of testing.
HIV Medicine. 2018;19(2):118-122. © 2018 Blackwell Publishing
