ObjectivesKey populations, including sex workers, men who have sex with men, and people who inject drugs, have a high risk of HIV and sexually transmitted infections. We assessed the health and economic impacts of different HIV and syphilis testing strategies among three key populations in Viet Nam using a dual HIV/syphilis rapid diagnostic test (RDT).SettingWe used the spectrum AIDS impact model to simulate the HIV epidemic in Viet Nam and evaluated five testing scenarios among key populations. We used a 15-year time horizon and a provider perspective for costs.ParticipantsWe simulate the entire population of Viet Nam in the model.InterventionsWe modelled five testing scenarios among key populations: (1) annual testing with an HIV RDT, (2) annual testing with a dual RDT, (3) biannual testing using dual RDT and HIV RDT, (4) biannual testing using HIV RDT and (5) biannual testing using dual RDT.Primary and secondary outcome measuresThe primary outcome is incremental cost-effectiveness ratios. Secondary outcomes include HIV and syphilis cases.ResultsAnnual testing using a dual HIV/syphilis RDT was cost-effective (US$10 per disability-adjusted life year (DALY)) and averted 3206 HIV cases and treated 27 727 syphilis cases compared with baseline over 15 years. Biannual testing using one dual test and one HIV RDT (US$1166 per DALY), or two dual tests (US$5672 per DALY) both averted an additional 875 HIV cases, although only the former scenario was cost-effective. Annual or biannual HIV testing using HIV RDTs and separate syphilis tests were more costly and less effective than using one or two dual RDTs.ConclusionsAnnual HIV and syphilis testing using dual RDT among key populations is cost-effective in Vietnam and similar settings to reach global reduction goals for HIV and syphilis.
Objectives Key populations, including sex workers, men who have sex with men, and people who inject drugs, have a high risk of HIV and sexually transmitted infections (STIs). We assessed the health and economic impacts of different HIV and syphilis testing strategies among three key populations in Viet Nam using a dual HIV/syphilis rapid diagnostic test (RDT). Setting We used the Spectrum AIDS Impact Model to simulate the HIV epidemic in key populations in Viet Nam and evaluated five testing scenarios. We used a 15-year time horizon and all costs are from the provider's perspective. Participants We include the entire population of Viet Nam in the model. Interventions We model five testing scenarios among key populations: 1) annual testing with an HIV rapid diagnostic test (RDT), 2) annual testing with a dual RDT, 3) biannual testing using dual RDT and HIV RDT, 4) biannual testing using HIV RDT, and 5) biannual testing using dual RDTs. Primary and secondary outcome measures The primary outcome is incremental cost-effectiveness ratios (ICERS). Secondary outcomes include HIV and syphilis cases and costs for each proposed intervention. Results Annual testing using a dual HIV/syphilis RDT was cost saving and averted 3,206 HIV cases and treated 7,719 syphilis cases compared to baseline over 15 years. Biannual testing using one dual test and one HIV RDT, or two dual tests both averted an additional 875 HIV cases and were cost-effective ($1,024 and $2,518 per DALY averted, respectively). Annual or biannual HIV testing using HIV RDTs and separate syphilis tests were more costly and less effective than using one or two dual RDTs. Conclusions Annual or biannual HIV and syphilis testing using dual RDTs among key populations can be cost-effective and support countries in reaching global reduction goals for HIV and syphilis.
Among men who have sex with men who do not report receptive anal sex, 70% reported at least one behavior that involved direct contact with their anus and 14.1% tested positive for rectal gonorrhea/chlamydia.
Modeling studies suggest that transmission of gonorrhea and chlamydia to multiple anatomic sites within the same person is necessary to reproduce observed high rates of extragenital gonorrhea/chlamydia. Limited empiric behavioral data support this idea. In this cross-sectional study, we enrolled individuals assigned male at birth who reported sex with men (MSM) and denied receptive anal sex (RAS) in the past 2 years. Participants enrolled in-person at the Sexual Health Clinic in Seattle, Washington (December 2019–September 2021) or online (July 2021–September 2021), and completed a sexual history questionnaire that asked about specific sexual acts and sequence of those acts during their last sexual encounter. We enrolled 210 MSM during the 16-month recruiting period. The median number of sex acts reported at last sexual encounter was 4 (interquartile range 3–5). The most commonly reported acts at last sex were: kissing (83%), receiving oral sex (82%), and insertive anal sex (65%). There was substantial variability in the sequence of acts reported; no unique sequence of sex acts was reported by more than 12% of the population. Ninety percent of participants reported sequences of behaviors that could lead to gonorrhea or chlamydia transmission within the same person (respondent or partner); the most common of these combinations was kissing followed by receiving oral sex (64% reporting). Engaging in multiple sex acts within a single sexual encounter is common and may lead to gonorrhea/chlamydia transmission within the same person. This complicates empiric measurements of transmission probabilities needed to estimate population-level transmission. Supplementary Information The online version contains supplementary material available at 10.1007/s10508-022-02486-2.
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