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. 2016 Mar;3(3):e140-6.
doi: 10.1016/S2352-3018(16)00007-2. Epub 2016 Feb 8.

Effect of the US National HIV/AIDS Strategy targets for improved HIV care engagement: a modelling study

Maunank Shah  1 , Allison Perry  2 , Kathryn Risher  3 , Sunaina Kapoor  4 , Jeremy Grey  5 , Akshay Sharma  5 , Eli S Rosenberg  5 , Carlos Del Rio  5 , Patrick Sullivan  5 , David W Dowdy  3
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Effect of the US National HIV/AIDS Strategy targets for improved HIV care engagement: a modelling study

Maunank Shah et al. Lancet HIV. 2016 Mar.

Abstract

Background: The recently updated White House National HIV/AIDS Strategy (NHAS) includes specific progress indicators to improve the HIV care continuum in the USA, but the economic and epidemiological effect of achieving those indicators remains unclear. We aimed to project the impact of achieving NHAS goals on HIV incidence, prevalence, mortality, and costs among adults in the USA over 10 years.

Methods: We constructed a dynamic transmission model of HIV progression and care engagement based on literature sources and the most recent published US Centers for Disease Control and Prevention data. We specifically considered achievement of the 2020 targets set forth in NHAS progress indicator 1 (90% awareness of serostatus), indicator 4 (85% linkage within 1 month), and indicator 5 (90% of diagnosed individuals in care).

Findings: At current rates of engagement in the HIV care continuum, we project 524,000 (95% uncertainty range 442,000-712,000) new HIV infections and 375,000 deaths (364,000-578,000) between 2016 and 2025. Achievement of NHAS progress indicators 1 and 4 has modest epidemiological effect (new infections reduced by 2·0% and 3·9%, respectively). By contrast, increasing the proportion of diagnosed individuals in care (NHAS indicator 5) averts 52% (95% UR 47-56) of new infections. Achievement of all NHAS targets resulted in a 58% reduction (95% UR 52-61) in new infections and 128 000 lives saved (106,000-223,000) at an incremental health system cost of US$105 billion.

Interpretation: Achievement of NHAS progress indicators for screening, linkage, and particularly improving retention in care, can substantially reduce the burden of HIV in the USA, but continued and increased financial investment will be required.

Funding: The National Institutes of Health, the B Frank and Kathleen Polk Assistant Professorship in Epidemiology, Emory University CFAR, Johns Hopkins University CFAR, and CDC/NCHHSTP Epidemiological and Economic Modeling Agreement (5U38PS004646).

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Figures

Figure 1
Figure 1. Total new HIV infections over the next decade, by achievement of NHAS targets
Cumulative new HIV infections at varying levels of HIV care engagement. In the base-case scenario, the current rates of HIV care engagement (screening, linkage, retention in care) persist. In the NHAS scenarios, we project improvements in care engagement (through increased yearly screening, improved linkage to care after diagnosis, and reduced care disengagement) that allows achievement of NHAS indicators 1, 4, and 5 by 2020.
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