title: Potential impact on HIV incidence of higher HIV testing rates and earlier antiretroviral therapy initiation in MSM.
abstract: BACKGROUND
  Increased rates of testing, with early antiretroviral therapy (ART) initiation, represent a key potential HIV-prevention approach. Currently, in MSM in the United Kingdom, it is estimated that 36% are diagnosed by 1 year from infection, and the ART initiation threshold is at CD4 cell count 350/μl. We investigated what would be required to reduce HIV incidence in MSM to below 1 per 1000 person-years (i.e. <535 new infections per year) by 2030, and whether this is likely to be cost-effective.
  
  
  METHODS
  A dynamic, individual-based simulation model was calibrated to multiple data sources on HIV in MSM in the United Kingdom. Outcomes were projected according to future alternative HIV testing and ART initiation scenarios to 2030, considering also potential changes in levels of condomless sex.
  
  
  RESULTS
  For ART use to result in an incidence of close to 1/1000 person-years requires the proportion of all HIV-positive MSM with viral suppression to increase from below 60% currently to 90%, assuming no rise in levels of condomless sex. Substantial increases in HIV testing, such that over 90% of men are diagnosed within a year of infection, would increase the proportion of HIV-positive men with viral suppression to 80%, and it would be 90%, if ART is initiated at diagnosis. The scenarios required for such a policy to be cost-effective are presented.
  
  
  CONCLUSIONS
  This analysis provides targets for the proportion of all HIV-positive MSM with viral suppression required to achieve substantial reductions in HIV incidence.
authors.affiliation: aUCL bLondon School of Hygiene and Tropical Medicine cPublic Health England (PHE) dCity University London, London, UK eRigshospitalet, University of Copenhagen, Denmark fHIV i-Base, London, UK.
authors.forename: Andrew N
authors.initials: AN
authors.lastname: Phillips
authors.forename: Valentina
authors.initials: V
authors.lastname: Cambiano
authors.forename: Alec
authors.initials: A
authors.lastname: Miners
authors.forename: Fiona C
authors.initials: FC
authors.lastname: Lampe
authors.forename: Alison
authors.initials: A
authors.lastname: Rodger
authors.forename: Fumiyo
authors.initials: F
authors.lastname: Nakagawa
authors.forename: Alison
authors.initials: A
authors.lastname: Brown
authors.forename: O Noel
authors.initials: ON
authors.lastname: Gill
authors.forename: Daniela
authors.initials: D
authors.lastname: De Angelis
authors.forename: Jonathan
authors.initials: J
authors.lastname: Elford
authors.forename: Graham
authors.initials: G
authors.lastname: Hart
authors.forename: Anne M
authors.initials: AM
authors.lastname: Johnson
authors.forename: Jens D
authors.initials: JD
authors.lastname: Lundgren
authors.forename: Simon
authors.initials: S
authors.lastname: Collins
authors.forename: Valerie
authors.initials: V
authors.lastname: Delpech
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D044966:Anti-Retroviral Agents / Q000191:economics / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D003955:Diagnostic Tests, Routine / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology*; D018451:Homosexuality, Male; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents