Comparative evaluation of HIV testing interventions for men who have sex with men in the Netherlands: insights for a low-incidence setting

BackgroundAlthough the number of new HIV diagnoses among men who have sex with men (MSM) in the Netherlands has declined considerably, the recent plateau suggests ongoing transmission. In 2024, 29% of new diagnoses among MSM were in a late HIV stage, showing that the time between infection and diagnosis can still be substantially reduced. In low-incidence settings, infections introduced through immigration are increasingly important in sustaining transmission, highlighting the need to re-evaluate current testing guidelines. We assess targeted testing strategies among MSM in the Netherlands addressing these considerations. MethodsWe used an agent-based model of HIV transmission among MSM in the Netherlands, incorporating infections acquired domestically and abroad. For 2024 - 2040, we simulated testing interventions targeting different subgroups, including offering an HIV test to immigrants upon entry, increasing testing rates among MSM residing in the Netherlands, and combinations of these approaches. ResultsOffering HIV testing to immigrating MSM at the entry averted up to 94 (95-th % quantile interval, 95% QI -128 - 328) new infections over 15 years if at least 50% take the test. Increasing testing to every 7 months in the general MSM population achieved the largest reduction, with up to 508 (95% QI 292 - 900) infections averted. The same testing rate in MSM with more than 5 partners within the previous six months resulted in 340 (95% QI 132-592) infections averted. Combining testing at entry with 7-months testing among general resident MSM averted the most infections, 534 (95% QI 308 - 884). ConclusionsCombination of offering HIV test to immigrating MSM at the entry with 7-month testing frequency in the general resident MSM population can substantially reduce HIV infections. The difference in impact between targeting general MSM and those with relatively high recent partner numbers suggests that criteria for being at risk of having HIV need to expand. 1 Author summaryWhile HIV transmission among MSM in the Netherlands has decreased substantially over the last decade, it is still ongoing. In 2024, 29% of new HIV diagnoses in MSM were in individuals in late-stage of HIV infection, suggesting that the time between HIV acquisition and diagnosis should be shortened further. Additionally, in a low-incidence setting such as MSM in the Netherlands, introduction of HIV infections through immigration becomes more important. We evaluated several HIV testing strategies for this context, considering both immigrating MSM and resident MSM. While offering HIV test at entry point can avert many HIV infections, increasing testing rate in resident MSM to on average every seven months can avert substantially more HIV infections. The greatest impact is achieved when these approaches are combined: targeting both immigrating MSM and those already living in the country. This combined strategy requires the fewest additional tests per infection averted. Importantly, our simulations show that there are MSM living with undiagnosed HIV who do not necessarily meet the traditional criteria for being at risk. Improved testing strategies can help reach these individuals earlier, benefiting both public and their personal health.