(P419) HIV and syphilis testing for heterosexuals aged above 25 years in the Netherlands: possibilities for targeted testing at Sexual Health Centers

Objectives

Evaluation of countries’ sexually transmitted infections (STI) testing policy and awareness of efficiency is important. In the Netherlands, STI targeted testing policy for HIV/syphilis at sexual health clinics (SHCs) was evaluated for its efficiency in younger heterosexuals, but not for heterosexuals ≥25 years. Older heterosexuals are all tested for HIV/syphilis at SHCs in the Netherlands. To explore possibilities for increased efficiency of testing in heterosexuals aged >25, this study aimed to identify determinants predictive for HIV and syphilis diagnoses that could possibly be used in targeted testing strategies.

Methods

Dutch surveillance data of SHC consultations of women and heterosexual men >25 years between 2015-2021 were included. By univariate and multivariate logistic regression, determinants for HIV and/or syphilis diagnosis were analyzed. Based on these determinants and their applicability in SHC practice, different targeted testing scenarios were evaluated. For each scenario, the percentage of consultations involving HIV and syphilis testing and the total amount of missed HIV and syphilis diagnoses were calculated.

Results

109,122 consultations were included among 75,718 individuals. The strongest determinants for HIV/syphilis diagnosis were HIV/syphilis-specific symptoms and receiving partner notification, followed by low/middle education level, male sex and age ≥30 years. When applying feasible determinants to targeted testing scenarios, HIV/syphilis testing would have been conducted in 54.5% of all consultations, missing 2 HIV and 3 syphilis diagnoses annually (13.4 and 11.4% of all diagnoses, resp.). Significant determinants for HIV/syphilis separately were originating from STI/HIV-endemic area and self-reported STI in the past year. When applying these determinants to scenarios, 0.3 HIV and 2 syphilis diagnoses annually would have been missed and HIV/syphilis testing would have been conducted in 74.2% of all consultations.

Conclusions

This study is a first step into considering targeted testing for older heterosexuals. In any targeted testing scenario studied, HIV and/or syphilis diagnoses would have been missed. This raises the question whether it is acceptable to put any of these targeted testing scenarios into practice. A discussion among a multidisciplinary team consisting of public health professionals, ethicists, economists, epidemiologists and others involved in policy making about the impact of targeted testing policy is needed.