Effect of Screening and Treatment for Gonorrhea and Chlamydia on HIV Incidence among Men who Have Sex with Men in the United States: A Modeling Analysis

• Type of Material: Article
• Authors: Jeb Jones, Emory University; Adrien Le Guillou, Emory University; Thomas L Gift, Centers for Disease Control and Prevention; Harrell Chesson, Centers for Disease Control and Prevention; Kevin Delaney, Centers for Disease Control and Prevention; Cynthia Lyles, Centers for Disease Control and Prevention; Andres Berruti, Centers for Disease Control and Prevention; Patrick S Sullivan, Emory University; Samuel M. Jenness, Emory University
• Language: English
• Date: 2022-07-28
• Publisher: Wolters Kluwer Health, Inc.
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2022 American Sexually Transmitted Diseases Association. All rights reserved.
• Final Published Version (URL): https://doi.org/10.1097%2FOLQ.0000000000001685
• Title of Journal or Parent Work: Sexually Transmitted Diseases
• Volume: 49
• Issue: 10
• Start Page: 669
• End Page: 676
• Grant/Funding Information: The authors acknowledge funding for this work from the Centers for Disease Control and Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention (U38PS004650).
• Keywords: HIV; screening and treatment; incidence; gonorrhea; chlamydia
• Research Categories: Health Sciences, Public Health; Health Sciences, Medicine and Surgery; Health Sciences, Epidemiology

Abstract

Background: Previous models have estimated the total population attributable fraction of NG/CT on HIV incidence among men who have sex with men (MSM), but this does not represent realistic intervention effects. We estimated the potential impact of screening for NG/CT on downstream incidence of HIV among MSM. Methods: Using a network model, we estimated the effects of varying coverage levels for STI screening among different priority populations: all sexually active MSM regardless of HIV serostatus, MSM with multiple recent (past 6 months) sex partners regardless of serostatus, MSM without HIV, and MSM with HIV. Under the assumption that all screening events included a urethral test, we also examined the effect of increasing of the proportion of screening events that include rectal screening for NG/CT on HIV incidence. Results: Increasing annual NG/CT screening among sexually active MSM by 60% averted 4.7% of HIV infections over a 10-year period (interquartile range (IQR): 2.3, 7.3). More HIV infections were averted when screening was focused on MSM with multiple recent sex partners: 60% coverage among MSM with multiple recent sex partners averted 9.8% of HIV infections (IQR: 8.1, 11.6). Increased STI screening among MSM without HIV averted more new HIV infections compared to the transmissions averted due to screening MSM with HIV, but fewer NG/CT tests were needed among MSM with HIV to avert a single new HIV infection. Conclusions: NG/CT screening among MSM is expected to lead to modest but clinically relevant reductions in HIV incidence among MSM.