What Will It Take to Reduce HIV Incidence in the United States: A Mathematical Modeling Analysis. (6th January 2018)

• Record Type: Journal Article
• Authors: Perry, Allison; Kasaie, Parastu; Dowdy, David W; Shah, Maunank
• Is Part Of: Open forum infectious diseases. Volume 5:Number 2(2018)
• Publication Date: 2018-01-06
• Subjects: HIV care-continuum -- HIV/AIDS -- linkage to care -- retention in care -- mathematical model -- economics; Communicable diseases -- Periodicals; Medical microbiology -- Periodicals; Infection -- Periodicals; 616.9
• DOI: 10.1093/ofid/ofy008
• Languages: English
• ISSNs: 2328-8957

Abstract

Abstract: Background: The National HIV/AIDS Strategy has set ambitious goals to improve the epidemic in the United States. However, there is a paucity of usable program-level benchmarks tied to population-level epidemiologic goals. Our objective was to define tangible benchmarks for annual rates along the care continuum that are likely to translate to meaningful reductions in incidence. Methods: We used a validated mathematical model of HIV transmission and care engagement to characterize care continuum parameters that would translate into 50% reductions in incidence by 2025, compared with a base case scenario of the current US care continuum. We generated a large pool of simulations in which rates of screening, linkage, and retention in care were varied across wide ranges to evaluate permutations that halved incidence by 2025. Results: Among all simulations, 7% achieved a halving of incidence. It was impossible for our simulations to achieve this target if the annual rate of disengagement from care exceeded 20% per year, even at high rates of care reengagement. When retention in care was 95% per year and people living with HIV (PLWH) out of care reengaged within 1.5 years (on average), the probability of halving incidence by 2025 was approximately 90%. Conclusions: HIV programs should aim to retain at least 95% of PLWH in care annually and reengage people living with HIV into care within an average of 1.5 years to achieve the goal of halving HIV incidence by 2025.