Estimating the potential to prevent locally acquired HIV infections in a UNAIDS Fast-Track City, Amsterdam
Alexandra Blenkinsop, M\'elodie Monod, Ard van Sighem, Nikos Pantazis,, Daniela Bezemer, Eline Op de Coul, Thijs van de Laar, Christophe Fraser,, Maria Prins, Peter Reiss, Godelieve de Bree, Oliver Ratmann

TL;DR
This study estimates undiagnosed HIV infections and local transmission rates in Amsterdam, revealing significant potential for targeted interventions to further reduce new HIV cases among diverse populations.
Contribution
It introduces a novel phylogenetic and Bayesian approach to quantify undiagnosed and locally acquired HIV infections in a major city.
Findings
20% of MSM infections were undiagnosed by 2019
44% of heterosexual infections were undiagnosed
68% of MSM infections in 2014-2018 were locally acquired
Abstract
Amsterdam and other UNAIDS Fast-Track cities aim for zero new HIV infections. Utilising molecular and clinical data of the ATHENA observational HIV cohort, our primary aims are to estimate the proportion of undiagnosed HIV infections and the proportion of locally acquired infections in Amsterdam in 2014-2018, both in MSM and heterosexuals and Dutch-born and foreign-born individuals. We located diagnosed HIV infections in Amsterdam using postcode data at time of registration to the cohort, and estimated their date of infection using clinical HIV data. We then inferred the proportion undiagnosed from the estimated times to diagnosis. To determine sources of Amsterdam infections, we used HIV sequences of people living with HIV (PLHIV) within a background of other Dutch and international sequences to phylogenetically reconstruct transmission chains. Frequent late diagnoses indicate that…
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Taxonomy
TopicsHIV, Drug Use, Sexual Risk · HIV/AIDS Research and Interventions · Syphilis Diagnosis and Treatment
