Impact of increased diagnosis for early HIV infection and immediate antiretroviral treatment initiation on HIV transmission among men who have sex with men in the Netherlands

Abstract

AbstractThe number of new HIV infections among men who have sex with men (MSM) in the Netherlands has been decreasing, but additional efforts are required to bring it further down. This study aims to assess the impact of increased diagnosis for early HIV infection combined with immediate antiretroviral treatment (ART) initiation on reducing HIV transmission among MSM. We developed an agent-based model calibrated to HIV surveillance and sexual behavior data for MSM in the Netherlands. We simulated a 10-year intervention that accelerates HIV diagnosis during the first 3 or 6 months after HIV acquisition across five levels of increased diagnosis rates (2, 4, 8, 16, and 32-fold), followed by immediate ART initiation. The upper limit of the intervention’s impact over 10 years is projected to lower median cumulative HIV infections from 469 (interquartile range [IQR]: 300–681), projected without the intervention, to 184 (IQR: 142-–239), denoted as maximum impact. A 16-fold increase in the diagnosis rate within 3 months after HIV acquisition results in 263 (IQR: 182–349) infections. Further increases in the diagnosis rate show diminishing returns, failing to reach the maximum impact. By extending the scope of the intervention to individuals who acquired HIV infection within the previous 6 months, a 16-fold increase in the diagnosis rate approaches closely the maximum impact of the intervention. Accelerating early HIV diagnosis through increased awareness, screening, and testing can further reduce transmission among MSM, provided diagnosis rates rise significantly. Meeting this goal necessitates a stakeholder needs assessment.Author summaryIn recent years, in the Netherlands, the annual number of new HIV infections in the population of men who have sex with men (MSM) has been declining. Using an agent-based model calibrated to the current state of the HIV epidemic in MSM in the Netherlands, we explored the potential impact of an intervention that accelerates diagnosis in individuals with early HIV infection and facilitates immediate antiretroviral treatment initiation on further reducing the number of new HIV infections. Our projections indicate that such an intervention can noticeably reduce onward HIV transmission in the population of MSM. To achieve this, the diagnosis rate for individuals with early HIV infection would need to increase 16-fold. Increasing the diagnosis rate beyond this level is expected to bring marginal improvements, without approaching the maximum potential of the intervention. Extending the intervention to target individuals who acquired HIV within the previous 6 months could further lower the number of new HIV infections, bringing it closer to the maximum impact. Therefore, the intervention, which achieves an increased diagnosis rate in individuals with early HIV who then immediately initiate ART, can bring forth substantial reductions in new HIV infections, even against a backdrop of an already declining trend of the HIV epidemic.