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Sexually Transmitted Diseases:
doi: 10.1097/OLQ.0000000000000046
Original Study

Replacing Clinic-Based Tests With Home-Use Tests May Increase HIV Prevalence Among Seattle Men Who Have Sex With Men: Evidence From a Mathematical Model

Katz, David A. PhD, MPH*; Cassels, Susan L. PhD, MPH†‡; Stekler, Joanne D. MD, MPH*†§

Supplemental Author Material
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Abstract

Background

Home-use tests have potential to increase HIV testing but may increase the rate of false-negative tests and decrease linkage to HIV care. We sought to estimate the impact of replacing clinic-based testing with home-use tests on HIV prevalence among men who have sex with men (MSM) in Seattle, Washington.

Methods

We adapted a deterministic, continuous-time model of HIV transmission dynamics parameterized using a 2003 random digit dial study of Seattle MSM. Test performance was based on the OraQuick In-Home HIV Test (OraSure Technologies, Inc, Bethlehem, PA) for home-use tests and, on an average, of antigen-antibody combination assays and nucleic acid amplification tests for clinic-based testing.

Results

Based on observed levels of clinic-based testing, our baseline model predicted an equilibrium HIV prevalence of 18.6%. If all men replaced clinic-based testing with home-use tests, prevalence increased to 27.5% if home-use testing did not impact testing frequency and to 22.4% if home-use testing increased testing frequency 3-fold. Regardless of how much home-use testing increased testing frequency, any replacement of clinic-based testing with home-use testing increased prevalence. These increases in HIV prevalence were mostly caused by the relatively long window period of the currently approved test. If the window period of a home-use test were 2 months instead of 3 months, prevalence would decrease if all MSM replaced clinic-based testing with home-use tests and tested more than 2.6 times more frequently.

Conclusions

Our model suggests that if home-use HIV tests replace supplement clinic-based testing, HIV prevalence may increase among Seattle MSM, even if home-use tests result in increased testing.

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