A new 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) in the United States. The report, led by researchers at the Massachusetts General Hospital (MGH), is being published online in Clinical Infectious Diseases.
"Young men who have sex with men account for one in five new HIV infections in the United States. 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 in the U.S. 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."
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.
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, even if 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 in the U.S." 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.
The Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) 110 and 113 studies were supported from the National Institutes of Health through the Eunice Kennedy Shriver National Institute of Child Health and Human Development, with supplemental funding from the National Institute on Drug Abuse and the National Institute of Mental Health.
The study also received funding from the Eleanor and Miles Shore Scholars in Medicine Fellowship; the Harvard University Center for AIDS; the Eunice Kennedy Shriver National Institute for Child Health and Human Development; the International Maternal Pediatric AIDS Clinical Trials Network Early Investigator Award; the National Institute of Allergy and Infectious Diseases; the UCLA Center for HIV Identification, Prevention, and Treatment Services (CHIIPTS) National Institute of Mental Health; the UCLA Center for AIDS Research; the UCLA Clinical Translational Science Institute (CTSI); the National Institute on Drug Abuse; the National Institute of Mental Health; and the Steve and Deborah Gorlin MGH Research Scholars Award.
About the Massachusetts General Hospital
Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The MGH Research Institute conducts the largest hospital-based research program in the nation, with an annual research budget of more than $1 billion and comprises more than 9,500 researchers working across more than 30 institutes, centers and departments. In August 2020 the MGH was named #6 in the nation by U.S. News & World Report in it