Replacing clinic-based tests with home-use tests may increase HIV prevalence among Seattle men who have sex with men: evidence from a mathematical model

Sex Transm Dis. 2014 Jan;41(1):2-9. doi: 10.1097/OLQ.0000000000000046.


Background: Home-use tests have potential to increase HIV testing but may increase the rate of false-negative tests and decrease linkage to HIV care. We sought to estimate the impact of replacing clinic-based testing with home-use tests on HIV prevalence among men who have sex with men (MSM) in Seattle, Washington.

Methods: We adapted a deterministic, continuous-time model of HIV transmission dynamics parameterized using a 2003 random digit dial study of Seattle MSM. Test performance was based on the OraQuick In-Home HIV Test (OraSure Technologies, Inc, Bethlehem, PA) for home-use tests and, on an average, of antigen-antibody combination assays and nucleic acid amplification tests for clinic-based testing.

Results: Based on observed levels of clinic-based testing, our baseline model predicted an equilibrium HIV prevalence of 18.6%. If all men replaced clinic-based testing with home-use tests, prevalence increased to 27.5% if home-use testing did not impact testing frequency and to 22.4% if home-use testing increased testing frequency 3-fold. Regardless of how much home-use testing increased testing frequency, any replacement of clinic-based testing with home-use testing increased prevalence. These increases in HIV prevalence were mostly caused by the relatively long window period of the currently approved test. If the window period of a home-use test were 2 months instead of 3 months, prevalence would decrease if all MSM replaced clinic-based testing with home-use tests and tested more than 2.6 times more frequently.

Conclusions: Our model suggests that if home-use HIV tests replace supplement clinic-based testing, HIV prevalence may increase among Seattle MSM, even if home-use tests result in increased testing.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Ambulatory Care Facilities / statistics & numerical data*
  • Condoms / statistics & numerical data
  • False Negative Reactions
  • HIV Seropositivity / diagnosis*
  • Health Knowledge, Attitudes, Practice
  • Health Services Accessibility / statistics & numerical data
  • Homosexuality, Male*
  • Humans
  • Male
  • Mass Screening
  • Models, Theoretical
  • Nucleic Acid Amplification Techniques*
  • Prevalence
  • Reagent Kits, Diagnostic*
  • Risk Assessment
  • Self Care*
  • Sexual Behavior* / statistics & numerical data
  • Washington / epidemiology


  • Reagent Kits, Diagnostic