title: Individualized diagnosis interventions can add significant effectiveness in reducing human immunodeficiency virus incidence among men who have sex with men: insights from Southern California.
abstract: OBJECTIVE
  In this article, we examine the effectiveness of a variety of HIV diagnosis interventions in recently HIV-diagnosed men who have sex with men (MSM). These interventions use the preventive potential of postdiagnosis behavior change (PDBC), as measured by the reduction in the number of new infections. Empirical evidence for PDBC was presented in the behavioral substudy of the Southern California Acute Infection and Early Disease Research Program. In previous modeling work, we demonstrated the existing preventive effects of PDBC. However, a large proportion of new infections among MSM are either undiagnosed or diagnosed late, and the preventive potential of PDBC is not fully utilized.
  
  
  METHODS
  We derive empirical, stochastic, network-based models to examine the effectiveness of several diagnosis interventions that account for PDBC among MSM over a 10-year period. These interventions involve tests with shorter detection windows, more frequent testing, and individualized testing regimens.
  
  
  RESULTS
  We find that individualized testing interventions (i.e., testing individuals every three partners or 3 months, whichever is first, or every six partners or 6 months, whichever is first) result in significantly fewer new HIV infections than the generalized interventions we consider.
  
  
  CONCLUSIONS
  This work highlights the potential of individualized interventions for new public health policies in HIV prevention.
authors.affiliation: Department of Medicine, University of Chicago, Chicago, IL. Electronic address: akhanna@medicine.bsd.uchicago.edu.
authors.forename: Aditya
authors.initials: A
authors.lastname: Khanna
authors.affiliation: Department of Anthropology, University of Washington, Seattle, WA.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Goodreau
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA.
authors.forename: Dan
authors.initials: D
authors.lastname: Wohlfeiler
authors.affiliation: David Geffen School of Medicine, University of California, Los Angeles, CA.
authors.forename: Eric
authors.initials: E
authors.lastname: Daar
authors.affiliation: Department of Medicine, University of California, San Diego, CA.
authors.forename: Susan
authors.initials: S
authors.lastname: Little
authors.affiliation: Fielding School of Public Health, David Geffen School of Medicine, University of California, Los Angeles, CA.
authors.forename: Pamina M
authors.initials: PM
authors.lastname: Gorbach
mesh_terms: D015492:AIDS Serodiagnosis; D002140:California / Q000453:epidemiology; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control*; D018451:Homosexuality, Male; D006801:Humans; D015994:Incidence; D008297:Male; D057285:Precision Medicine; D040242:Risk Reduction Behavior; D012309:Risk-Taking; D012747:Sexual Partners; D055815:Young Adult
keywords: Diagnosis strategies; Exponential random graph models (ERGMs); Men who have sex with men (MSM); Network models; Testing as prevention