Increasing screening frequency in men who have sex with men: impact of guidance on risk profiling on workload and earlier diagnosis of sexually transmitted infection and HIV

Abstract

Increasing screening frequency in men who have sex with men (MSM) engaging in high-risk behaviours can reduce prevalence of sexually transmitted infections (STIs). This evaluation investigated the impact of applying stricter screening guidelines for MSM on service workload and earlier STI diagnoses. A validated risk assessment tool (RAT) was distributed to MSM attending a level 3 sexual health service over three months. Australian screening guidelines were applied to the data to identify MSM requiring more frequent screening and data projected to the larger MSM population. The RAT identified a 2-5-fold increase in the number of STI and HIV screenings required based on six- and three-monthly screening intervals, respectively, in the MSM cohort. When screening intervals are reduced from three-monthly to six-monthly there is a potential loss of 66.7% of earlier HIV diagnoses. The use of RATs will increase workload in sexual health services, but potentially diagnose a large proportion of disease earlier.

Evidence for optimal HIV screening and testing intervals in HIV-negative individuals from various risk groups: A systematic review

“…The majority of the evidence came from 20 modelling studies (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37). There was one descriptive study (38); three non-economic modelling studies (39)(40)(41); one cohort study (42); one cross-sectional study (43); and one mixed-methods study (descriptive and modelling) (44). The included studies were conducted in various countries, including 14 in the United States (US), three in Australia and two in the United Kingdom (UK).…”

“…The search identified 14 studies that addressed the optimal HIV screening interval among MSM. Eight studies were economic modelling studies (19,20,(22)(23)(24)(25)32,37) and five were modelling studies without economic inputs (38,(40)(41)(42)44). Recommended testing frequencies ranged from one-time only, to annually and to once every three months.…”

“…Modelling studies that scored low/ moderate quality did not provide strong rationales for the background and analysis. The study by Baker et al reported the only descriptive study and it received only a moderate score due to the lack of generalizability to the target population, data collection sources and methods used, analysis plan and strength of study design (38).…”

How to do it: setting up an asymptomatic screening pathway for men who have sex with men

“…However, there is a lack of consistent evidence about what constitutes ‘high risk’ 7. One study found defining high risk as unprotected anal intercourse, 10 or more partners in the last 6 months, chemsex or group sex showed the greatest potential gains 24. Our questions aim to identify high-risk sexual behaviours and those who require hepatitis C testing, and those who have not visited our service before, to ensure that all MSM are being seen in person at some point.…”

Données probantes portant sur l’optimisation de la fréquence des tests de dépistage du VIH chez des personnes séronégatives issues de divers groupes à risque : revue systématique

“…EXAMEN SYSTÉMATIQUEétude descriptive(38), trois études de modélisation non économique(39)(40)(41), une étude de cohorte(42), une étude transversale(43) et une étude combinée (descriptive et de modélisation)(44). Les études comprises ont été menées dans divers pays, y compris 14 aux États-Unis, trois en Australie et deux au RoyaumeUni.…”