Repeat HIV-testing is associated with an increase in behavioral risk among men who have sex with men: a cohort study

Abstract

Background: The Center for Disease Control and Prevention recommends that high-risk groups, like sexually active men who have sex with men (MSM), receive HIV testing and counseling at least annually. The objective of this study was to investigate the relationship between voluntary repeat HIV testing and sexual risk behavior in MSM receiving rapid serologic and nucleic acid amplification testing.

Methods: We performed a cohort study to analyze reported risk behavior among MSM receiving the "Early Test", a community-based, confidential acute and early HIV infection screening program in San Diego, California, between April 2008 and July 2014. The study included 8,935 MSM receiving 17,333 "Early Tests". A previously published risk behavior score for HIV acquisition in MSM (i.e. Menza score) was chosen as an outcome to assess associations between risk behaviors and number of repeated tests.

Results: At baseline, repeat-testers (n = 3,202) reported more male partners and more condomless receptive anal intercourse (CRAI) when compared to single-testers (n = 5,405, all P <0.001). In 2,457 repeat testers there was a strong association observed between repeated HIV tests obtained and increased risk behavior, with number of male partners, CRAI with high risk persons, non-injection stimulant drug use, and sexually transmitted infections all increasing between the first and last test. There was also a linear increase of risk (i.e. high Menza scores) with number of tests up to the 17th test. In the multivariable mixed effects model, more HIV tests (OR = 1.18 for each doubling of the number of tests, P <0.001) and younger age (OR = 0.95 per 5-year increase, P = 0.006) had significant associations with high Menza scores.

Conclusions: This study found that the highest risk individuals for acquiring HIV (e.g. candidates for antiretroviral pre-exposure prophylaxis) can be identified by their testing patterns. Future studies should delineate causation versus association to improve prevention messages delivered to repeat testers during HIV testing and counseling sessions.

Fig. 1

Tree of enrollment for analyses on baseline risk-taking behavior in single- and repeat-testers and risk behavior increase in repeat-testers (reasons/number of excluded individuals are displayed in grey shapes)

Fig. 2

Percentage of high (i.e. ≥5 Menza-score points) HIV behavioral risk scores as modified from [23], by number of HIV tests in repeat testers. The bubble size reflects the denominator used to calculate the percentage of high scores. Linear Reg stands for linear regression, assuming a linear relationship between the y-axis (high risk score) and the x-axis (number of tests). Loess stands for local regression, a smoothing technique that allows one to see a pattern without assuming a particular distribution