High Linkage to Care in a Community-Based Rapid HIV Testing and Counseling Project Among Men Who Have Sex With Men in Copenhagen

INTRODUCTION: The aim of the study was to evaluate a community-based human immunodeficiency virus (HIV) testing program for its capacity to reach men who have sex with men (MSM) and successfully refer HIV-positive patients to treatment.

METHODS: A walk-in clinic placed in the heart of the Copenhagen MSM community provided sexually transmitted infection counseling and rapid HIV testing. In addition, syphilis testing and hepatitis B vaccination were offered. The clinic was staffed with specially trained, predominantly non-health care personnel, and services were anonymous and free of charge.

RESULTS: A total of 3012 HIV tests with concomitant counseling were performed between 2008 and 2012. The median age of users was 33 years (range, 16-73 years), 18% were non-Danish citizens, and 12% reported that this was their first HIV test. Thirty-eight individuals tested positive; however, 1 was found to be false positive by routine confirmatory testing. The remaining 37 users were true positive. All but 1 user was successfully linked to care at an infectious disease department and achieved full viral suppression after a median of 8 months (interquartile range, 5-19 months). The 37 positive patients accounted for 11% of all newly diagnosed HIV cases among MSM in Copenhagen in the period covered. Patients diagnosed in Checkpoint were younger than other newly diagnosed MSM, but had similar median CD4 counts at the time of diagnosis (420 [interquartile range, 260-590]). Seventy-six MSM (3%) were found syphilis positive in rapid testing and referred for confirmatory testing. Furthermore, 264 MSM completed a 3-shot hepatitis B vaccination program.

CONCLUSIONS: Easily accessible, community walk-in clinics and targeted testing in high-risk settings are convenient for populations of MSM less likely to seek out the established health care system. Checkpoint diagnosed 37 new HIV cases, posed no barrier to successful linkage to care, was noninferior in quickly reducing community viral load, was cost-effective, reached younger MSM, and proved an ideal platform for trying out new interventions and test forms, which conventional health care providers have not yet embraced.