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.
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.
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DOI：
10.1097/olq.0000000000000046
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发表时间：
2014-01
影响因子：
3.1
通讯作者：
Stekler JD
中科院分区：
文献类型：
--
作者：
Katz DA;Cassels SL;Stekler JD
家用检测有可能增加艾滋病毒检测，但可能增加假阴性检测率，并减少与艾滋病毒护理的联系。我们试图估计用家用检测取代诊所检测对华盛顿州西雅图男男性行为者（MSM）艾滋病毒感染率的影响。我们采用了一个确定性的，连续时间模型的艾滋病毒传播动力学参数化使用2003年的随机数字拨号研究西雅图男男性接触者。测试性能基于用于家用测试的OraQuick In-Home HIV Test（OraSure Technologies，Inc，Bethlehem，PA），以及用于基于临床的测试的抗原抗体组合测定和核酸扩增测试的平均值。根据观察到的基于诊所的检测水平，我们的基线模型预测了18.6%的平衡艾滋病毒流行率。如果所有男性都用家庭测试取代诊所测试，如果家庭测试不影响测试频率，患病率增加到27.5%，如果家庭测试将测试频率增加3倍，患病率增加到22.4%。无论家用检测增加了多少检测频率，任何以家用检测取代诊所检测都会增加患病率。艾滋病毒流行率的增加主要是由于目前批准的测试窗口期相对较长。如果家庭使用测试的窗口期为2个月而不是3个月，如果所有MSM都用家庭使用测试取代基于诊所的测试，并且测试频率增加2.6倍以上，则患病率会降低。我们的模型表明，如果家庭使用的艾滋病毒检测取代补充诊所为基础的测试，艾滋病毒的流行率可能会增加西雅图男男性接触者，即使家庭使用的测试结果增加测试。
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. 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. 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. 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.