TY - JOUR
T1 - Effect of the US National HIV/AIDS Strategy targets for improved HIV care engagement
T2 - A modelling study
AU - Shah, Maunank
AU - Perry, Allison
AU - Risher, Kathryn
AU - Kapoor, Sunaina
AU - Grey, Jeremy
AU - Sharma, Akshay
AU - Rosenberg, Eli S.
AU - Del Rio, Carlos
AU - Sullivan, Patrick
AU - Dowdy, David W.
N1 - Publisher Copyright:
© 2016 Elsevier Ltd.
PY - 2016/3/1
Y1 - 2016/3/1
N2 - 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).
AB - 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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U2 - 10.1016/S2352-3018(16)00007-2
DO - 10.1016/S2352-3018(16)00007-2
M3 - Article
C2 - 26939737
AN - SCOPUS:84959216302
SN - 2352-3018
VL - 3
SP - e140-e146
JO - The Lancet HIV
JF - The Lancet HIV
IS - 3
ER -
