Speaker
Description
Background: Despite declining HIV diagnoses among men who have sex with men (MSM) in the Netherlands, a recent plateau and the high proportion of late-stage diagnoses (29% in 2024) indicate ongoing transmission and delayed detection. Infections introduced through immigration are increasingly relevant in this low-incidence setting, motivating a reassessment of testing guidelines, which we evaluate in this study.
Methods: We used an agent-based model of HIV transmission among MSM in the Netherlands, incorporating domestic and imported infections. For 2024–2040, we simulated targeted testing strategies, including testing at immigration, increased testing among resident MSM, and combined approaches.
Results: Testing immigrating MSM at entry averted up to 94 infections over 15 years (95% QI 128–328) with ≥50% uptake. Increasing testing to every 7 months among general resident MSM achieved the largest reduction, with 508 infections averted (95% QI 292–900), followed by targeting MSM with >5 partners within the previous six months (340; 95% QI 132–592). Combining entry testing with 7-monthly testing among resident MSM yielded the greatest impact (534; 95% QI 308–884).
Conclusions: Combining HIV testing at entry for immigrating MSM with 7-monthly testing among resident MSM can substantially reduce infections. The greater impact of population-wide versus risk-targeted testing suggests that current risk-based testing criteria may be too narrow.
