|Title||What Will It Take to Reduce HIV Incidence in the United States: A Mathematical Modeling Analysis.|
|Publication Type||Journal Article|
|Year of Publication||2018|
|Authors||Perry A, Kasaie P, Dowdy DW, Shah M|
|Journal||Open Forum Infect Dis|
|Date Published||2018 Feb|
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.
|Alternate Journal||Open Forum Infect Dis|
|PubMed Central ID||PMC5798078|
|Grant List||P30 AI094189 / AI / NIAID NIH HHS / United States|