Cost-utility of HIV Testing Programs Among Men Who Have Sex with Men in the United States.

Few groups in the United States (US) are as heavily affected by HIV as men who have sex with men (MSM), yet many MSM remain unaware of their infection. HIV diagnosis is important for decreasing onward transmission and promoting effective treatment for HIV, but the cost-effectiveness of testing programs is not well-established. This study reports on the costs and cost-utility of the MSM Testing Initiative (MTI) to newly diagnose HIV among MSM and link them to medical care. Cost and testing data in 15 US cities from January 2013 to March 2014 were prospectively collected and combined to determine the cost-utility of MTI in each city in terms of the cost per Quality Adjusted Life Years (QALY) saved from payer and societal perspectives. The total venue-based HIV testing costs ranged from $18,759 to $564,284 for nine to fifteen months of MTI implementation. The cost-saving threshold for HIV testing of MSM was $20,645 per new HIV diagnosis. Overall, 27,475 men were tested through venue-based MTI, of whom 807 (3 %) were newly diagnosed with HIV. These new diagnoses were associated with approximately 47 averted HIV infections. The cost per QALY saved by implementation of MTI in each city was negative, indicating that MTI venue-based testing was cost-saving in all cities. The cost-utility of social network and couples testing strategies was, however, dependent on whether the programs newly diagnosed MSM. The cost per new HIV diagnosis varied considerably across cities and was influenced by both the local cost of MSM testing implementation and by the seropositivity rate of those reached by the HIV testing program. While the cost-saving threshold for HIV testing is highly achievable, testing programs must successfully reach undiagnosed HIV-positive individuals in order to be cost-effective. This underscores the need for HIV testing programs which target and engage populations such as MSM who are most likely to have undiagnosed HIV to maximize programmatic benefit and cost-utility.

Risk Behaviors and Testing History of African American MSM: Implications for Prevention.

OBJECTIVES: Knowledge of HIV status is an important step in prevention efforts especially for at risk populations like MSM. CDC recommends that MSM be tested at least annually. There is a limited information on the demographics and risk behaviors of MSM who never tested or test infrequently. This study examined the demographic characteristics, risk behaviors, and HIV status of African American MSM who reported never previously testing for HIV, testing > 12 months prior, or testing within the last 12 months from a testing evaluation study in Washington, D.C. METHODS: Eligibility requirements were: 18-64 years old; Black/African American; biologically male; and self-reported oral and/or anal sex with a man in the past six months. Descriptive statistics and logistic regression analyses were used. RESULTS: Men who never tested had greater odds of being 25-34 years old, identifying as bisexual or heterosexual and reporting condomless sex with female and male partners. In the multivariate model, men who never tested or tested > 12 months prior to the study had a greater likelihood of having a BS degree, and being age 35 or over. Being newly identified as HIV-positive was associated with never testing and testing > 12 months prior, but was significant in the multivariate model only for never testing. CONCLUSION: Results suggest prevention strategies should target risk behaviors rather than orientation and engage older men. Future studies should identify factors associated with risky sexual behaviors for men who never test or test infrequently in order to inform prevention interventions.

Comparison of strategies to increase HIV testing among African-American gay, bisexual, and other men who have sex with men in Washington, DC.

This paper presents results from a study conducted to compare the relative effectiveness of three strategies - alternate venue testing (AVT), the social network strategy (SNS), and partner counseling and referral services (PCRS; standard care) - for reaching and motivating previously undiagnosed, African-American men who have sex with men (AA MSM) to be tested for HIV. Data were collected between June 2008 and February 2010 at a gay-identified, community-based organization (CBO) serving AA MSM in Washington, DC. Men were eligible to participate if they were 18-64 years old, self-identified as black or African-American, were biologically male, and self-reported oral or anal sex with a man in the past six months. Fisher's exact test of independence was used to assess differences in demographics, testing history, HIV status and sexual behaviors across the three strategies. The final sample included 470 men who met all eligibility requirements. There were no statistically significant differences in HIV positivity rates across the three strategies. However, relative to standard care, the SNS, and (to a lesser degree) the AVT strategies were more successful in recruiting men that had never been tested. Additionally, the results indicate that each strategy recruited different subgroups of men. Specifically, heterosexually identified men and men who reported engaging in unprotected sex were most likely to be recruited via SNS. Bisexually identified men and older men were most likely to be recruited via AVT or SNS, while standard care tended to reach greater proportions of young men and homosexually identified men. These findings suggest that a combination of strategies may be the best approach for engaging African-American MSM in HIV testing.

Lessons learned from use of social network strategy in HIV testing programs targeting African American men who have sex with men.

OBJECTIVES: We report lessons derived from implementation of the Social Network Strategy (SNS) into existing HIV counseling, testing, and referral services targeting 18- to 64-year-old Black gay, bisexual, and other men who have sex with men (MSM). METHODS: The SNS procedures used in this study were adapted from a Centers for Disease Control and Prevention-funded, 2-year demonstration project involving 9 community-based organizations (CBOs) in 7 cities. Under the SNS, HIV-positive and HIV-negative men at high risk for HIV (recruiters) were enlisted to identify and recruit persons from their social, sexual, or drug-using networks (network associates) for HIV testing. Sites maintained records of modified study protocols for ascertaining lessons learned. The study was conducted between April 2008 and May 2010 at CBOs in Washington, DC, and New York, New York, and at a health department in Baltimore, Maryland. RESULTS: Several common lessons regarding development of the plan, staffing, training, and use of incentives were identified across the sites. Collectively, these lessons indicate use of SNS is resource-intensive, requiring a detailed plan, dedicated staff, and continual input from clients and staff for successful implementation. CONCLUSIONS: SNS may provide a strategy for identifying and targeting clusters of high-risk Black MSM for HIV testing. Given the resources needed to implement the strategy, additional studies using an experimental design are needed to determine the cost-effectiveness of SNS compared with other testing strategies.

A new approach to assessing affect and the emotional implications of personal genomic testing for common disease risk.

AIMS: Personal genomic testing (PGT) for common disease risk is becoming increasingly frequent, but little is known about people's array of emotional reactions to learning their genomic risk profiles and the psychological harms/benefits of PGT. We conducted a study of post-PGT affect, including positive, neutral, and negative states that may arise after testing. METHODS: A total of 228 healthy adults received PGT for common disease variants and completed a semistructured research interview within 2 weeks of disclosure. The study participants reported how the PGT results made them feel in their own words. Using an iterative coding process, the responses were organized into three broad affective categories: negative, neutral, and positive affect. RESULTS: Neutral affect was the most prevalent response (53.9%), followed by positive affect (26.9%) and negative affect (19.2%). We found no differences by gender, race, or education. CONCLUSIONS: While <20% of participants reported negative affect in response to learning their genomic risk profile for common diseases, a majority experienced either neutral or positive emotions. These findings contribute to the growing evidence that PGT does not impose significant psychological harms. Moreover, they point to a need to better link theories and assessments in both emotional and cognitive processing to capitalize on PGT information for healthy behavior change.