Modelling assessment of epidemiological strategies based on self-screening tools

Area of Science:

• Epidemiology
• Mathematical Modeling
• Public Health Interventions

Background:

• WHO recommends test-and-treat strategies for HIV and bacterial STI elimination by 2030.
• Current testing protocols may not meet required coverages for intervention success.
• Voluntary testing can increase rates if individuals perceive high benefits, with multi-disease kits being a key tool.

Purpose of the Study:

• To model individual decision-making for testing in an epidemiological context.
• To identify optimal combined testing strategies for HIV elimination.
• To analyze the impact of risk perception bias and PrEP coverage on testing effectiveness.

Main Methods:

• Individual-level decision-making mathematical models were constructed.
• The model focused on the HIV, syphilis, chlamydia, and gonorrhea epidemic in Parisian men-who-have-sex-with-men.
• Consideration was given to pre-exposure prophylaxis (PrEP) for HIV and potential risk perception biases.

Main Results:

• Unbiased perception of disease risk is optimal for HIV elimination.
• Combining HIV and syphilis voluntary testing is less effective for HIV elimination than HIV testing alone or with other STIs.
• This finding holds regardless of PrEP coverage and perception bias.

Conclusions:

• Combined testing for HIV and syphilis is not recommended as a voluntary strategy.
• Separate, distinct individual decisions for HIV and syphilis voluntary testing are advised.
• This approach is proposed to advance HIV elimination efforts.