Barriers for the MSM Population to Access Testing for HIV in France, Poland, the UK and Across Europe: A Qualitative Study
Jul 30, 2020
Published in: Journal of HIV/AIDS & Infectious Diseases, Volume 7, Number 102 (2020): doi: 10.17303/jaid.2020.7.102
Posted on RAND.org on July 30, 2020
Modelling studies have been undertaken in various contexts to project the effectiveness of the test and treat strategies for HIV worldwide. In this paper we present the findings from the calibration of a mathematical model built for LA county and adapted to the European context, focusing on France, Poland, and the UK, as well as predictions for these countries for different testing rates and an assessment of how these testing rates could be achieved. We used a systems dynamics approach to model the dynamics of HIV in the MSM population, dividing individuals into eight HIV infection statuses: susceptible and HIV negative (S), infected in the primary stage of infection (P), HIV+ unaware (I), diagnosed infected but not treatment-eligible according to the guidelines at the time of diagnosis(J), HIV+ and treatment-eligible (E), treated but no progression to AIDS (T), progression to AIDS but not treated (A), and progression to AIDS and treated (TA). Parameters informing the transmission model describe how HIV-positive MSM progress between disease states and treatment and the rate at which HIV positive MSM sexually transmit HIV to susceptible MSM. Our model shows the variability in the uptake of testing and treatment for HIV in the MSM population across three European countries. However, increasing the testing rate of HIV in MSM contributes to reducing the prevalence of HIV+ unaware MSM in different ways in the three countries. Additionally, increasing the testing rate leads to a reduction in the incidence of diagnosed HIV infection among MSM. However, we find that the possible marginal increases in testing rates are very different across the three countries. Increasing existing intervention policies to encourage testing and treating for HIV would be most beneficial to the MSM population in France and Poland. We showed our model can be used to predict the impact of policy changes on the populations in these countries going forward.