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What Will It Take to Reduce HIV Incidence in the United States: A Mathematical Modeling Analysis.

TitleWhat Will It Take to Reduce HIV Incidence in the United States: A Mathematical Modeling Analysis.
Publication TypeJournal Article
Year of Publication2018
AuthorsPerry A, Kasaie P, Dowdy DW, Shah M
JournalOpen Forum Infect Dis
Volume5
Issue2
Paginationofy008
Date Published2018 Feb
ISSN2328-8957
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.

DOI10.1093/ofid/ofy008
Alternate JournalOpen Forum Infect Dis
PubMed ID29423424
PubMed Central IDPMC5798078
Grant ListP30 AI094189 / AI / NIAID NIH HHS / United States