Falling HIV incidence in a community clinic cohort of men who have sex with men and transgender women in Barcelona, Spain.

In Barcelona, Spain prior to 2006, HIV testing was mostly limited to formal healthcare facilities with no incidence data reported. A community-based organization (BCN Checkpoint) was established to increase HIV testing in a peer-led community location to generate incidence data in men who have sex with men and transgender women. Three community engagement interventions were conducted between 2009 and 2017 as follows: 2009-2011 (peer-led point-of-care testing for HIV), 2012-2014 (12-monthly HIV testing with an emphasis on testing in partnerships), 2015-2017 (three-monthly HIV testing with rapid referral for antiretroviral initiation). Between 2009 and 2017 a predominantly cisgender male (99.4%) and Spanish national (62.4%) population with mean age of 34.8 years had 49,630 visits. Mean visit number increased from 1.69 in the first to 2.07 in the last three-year period. HIV incidence fell from 4.17 (95% confidence interval [CI]: 3.53-4.93) per 100 person-years in 2009-2011 to 1.57 (95% CI: 1.30-1.89) per 100 person-years in 2015-2017. This represents a 62% reduction (incidence rate ratio: 0.38, 95% CI: 0.29-0.48) between the first and third study period (p < 0.001). These early interventions may have contributed to the reduction seen in HIV incidence in this cohort.