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Impact of frequent testing on the transmission of HIV and N. gonorrhoeae among men who have sex with men: a mathematical modelling study
  1. Maarten Reitsema1,2,
  2. Janneke Heijne1,
  3. Maartje Visser1,
  4. Ard van Sighem3,
  5. Maarten Schim van der Loeff4,5,
  6. Eline L M op de Coul1,
  7. Daniela Bezemer3,
  8. Jacco Wallinga1,2,
  9. Birgit H B van Benthem1,
  10. Maria Xiridou1
  1. 1 Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
  2. 2 Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, The Netherlands
  3. 3 Stichting HIV Monitoring, Amsterdam, The Netherlands
  4. 4 Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands
  5. 5 Department of Internal Medicine, Amsterdam University Medical Centre, Amsterdam, The Netherlands
  1. Correspondence to Maria Xiridou, National Institute of Public Health and Environment, Bilthoven 3720 BA, The Netherlands; maria.xiridou{at}


Objectives To investigate the impact and efficiency of combined testing for HIV and other STIs on HIV and STI transmission among men who have sex with men (MSM) and to assess what subgroups of MSM should be targeted for frequent testing.

Methods We developed an agent-based transmission model that simulates infection with HIV or Neisseria gonorrhoeae (NG) among MSM. We examined scenarios with increased percentages of MSM getting tested six monthly, among all MSM or only specific subgroups of MSM (defined according to recent gonorrhoea, number of partners and engagement in condomless anal intercourse (CAI)) and scenarios with reduced intervals between HIV/STI tests.

Results The most efficient strategies were those with increased percentage of MSM getting tested every 6 months among MSM with a recent gonorrhoea diagnosis; or among MSM who had CAI and ≥10 partners; or MSM who had ≥10 partners. Over 10 years, these strategies resulted in 387–718 averted HIV infections and required 29–164 additional HIV tests per averted HIV infection or one to seven additional gonorrhoea tests per averted NG infection. The most effective strategy in reducing HIV transmission was the one where the intervals between tests were reduced by half, followed by the strategy with increased percentage of MSM getting tested every 6 months among all MSM. Over 10 years, these strategies resulted in 1362 and 1319 averted HIV infections, but required 663 and 584 additional HIV tests per averted HIV infection, respectively.

Conclusions Targeting MSM with recent gonorrhoea diagnosis or MSM with many partners is efficient in terms of HIV/STI tests needed to prevent new HIV or NG infections. Major reductions in HIV incidence can be achieved with consistent HIV/STI testing every 6 months among larger groups, including low-risk MSM. To impede HIV transmission, frequent testing should be combined with other prevention measures.

  • HIV
  • gonorrhoea
  • transmission model
  • HIV testing
  • STI testing

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  • Handling editor Katy M E Turner

  • Contributors Study concept and design: BHBvB, JH, MR, MX, MV. Analyses of data from external sources and literature review: MR, MV. Development of model and model analyses: MR, MX. Drafting of the article, interpretation of results, critical revision of the article: all authors.

  • Funding This project received financial support from Aidsfonds (project number 2014037).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.