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High Linkage to Care in a Community-Based Rapid HIV Testing and Counseling Project Among Men Who Have Sex With Men in Copenhagen

Qvist, Tavs MD*; Cowan, Susan Alice MD; Graugaard, Christian MD, PhD; Helleberg, Marie MD, PhD*

Sexually Transmitted Diseases: March 2014 - Volume 41 - Issue 3 - p 209–214
doi: 10.1097/OLQ.0000000000000096
Original Study

Introduction: The aim of the study was to evaluate a community-based human immunodeficiency virus (HIV) testing program for its capacity to reach men who have sex with men (MSM) and successfully refer HIV-positive patients to treatment.

Methods: A walk-in clinic placed in the heart of the Copenhagen MSM community provided sexually transmitted infection counseling and rapid HIV testing. In addition, syphilis testing and hepatitis B vaccination were offered. The clinic was staffed with specially trained, predominantly non–health care personnel, and services were anonymous and free of charge.

Results: A total of 3012 HIV tests with concomitant counseling were performed between 2008 and 2012. The median age of users was 33 years (range, 16–73 years), 18% were non-Danish citizens, and 12% reported that this was their first HIV test. Thirty-eight individuals tested positive; however, 1 was found to be false positive by routine confirmatory testing. The remaining 37 users were true positive. All but 1 user was successfully linked to care at an infectious disease department and achieved full viral suppression after a median of 8 months (interquartile range, 5–19 months). The 37 positive patients accounted for 11% of all newly diagnosed HIV cases among MSM in Copenhagen in the period covered. Patients diagnosed in Checkpoint were younger than other newly diagnosed MSM, but had similar median CD4 counts at the time of diagnosis (420 [interquartile range, 260–590]). Seventy-six MSM (3%) were found syphilis positive in rapid testing and referred for confirmatory testing. Furthermore, 264 MSM completed a 3-shot hepatitis B vaccination program.

Conclusions: Easily accessible, community walk-in clinics and targeted testing in high-risk settings are convenient for populations of MSM less likely to seek out the established health care system. Checkpoint diagnosed 37 new HIV cases, posed no barrier to successful linkage to care, was noninferior in quickly reducing community viral load, was cost-effective, reached younger MSM, and proved an ideal platform for trying out new interventions and test forms, which conventional health care providers have not yet embraced.

A community walk-in clinic providing sexually transmitted infection counseling, rapid HIV and syphilis testing, and hepatitis B vaccination proved effective in diagnosing and linking young HIV-infected men who have sex with men to care.

From the *Department of Infectious Diseases, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; †Department of Infectious Disease Epidemiology, Statens Serum Institut, Copenhagen, Denmark; and ‡Center for Sexology Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark

Acknowledgments: The authors would like to thank past and present Copenhagen Checkpoint staff: Thomas B. Andersen, Sami Beji, Niels Brix, Tina Bruun, Mogens Caprani, Philippa Collins, Jan Fouchard, Michael Funch, Thomas Haansbæk, Jakob Haff, Jeppe Hald, Bent Hansen, Tonny Bønløkke Hertz, Morten Hougård, Lene Pors Jensen, Per Slaaen Kaye, Klaus Legau, Francois Pichon, Mie Rix, Solveig Roth, Gyda Svanberg, Hanne Sørensen, Morten Vaagholt, and Jes Vitting. A special thanks to Jan Gerstoft, Niels Obel, and Lars Mathiesen and the staff at the Infectious Disease Departments of Rigshospitalet and Hvidovre Hospital.

Author’s contributions: T.Q.: study design, data collection, data analysis, writing of the manuscript; S.C.: data analysis and draft manuscript reading; C.G.: conceptualization and draft manuscript reading; and M.H.: study design, data analysis, and draft article reading. All authors read and approved the final manuscript.

The authors declare that they have no competing interests.

Correspondence: Tavs Qvist, MD, Department of Infectious Diseases, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, Copenhagen Ø, DK-2100, Denmark. E-mail: tavs.qvist@gmail.com.

Received for publication August 30, 2013, and accepted December 19, 2013.

© Copyright 2014 American Sexually Transmitted Diseases Association