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

The 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.