Quantifying the impact of the National HIV/AIDS strategy targets for improved HIV care engagement in the US: a modelling study
Published Date:Feb 08 2016
Source:Lancet HIV. 3(3):e140-e146.
Pubmed Central ID:PMC4787987
Funding:P30 AI050409/AI/NIAID NIH HHS/United States
5U38PS004646/PS/NCHHSTP CDC HHS/United States
K23AI089259/AI/NIAID NIH HHS/United States
T32AI102623/AI/NIAID NIH HHS/United States
K23 AI089259/AI/NIAID NIH HHS/United States
U38 PS004646/PS/NCHHSTP CDC HHS/United States
T32 AI102623/AI/NIAID NIH HHS/United States
The recently updated White House National HIV/AIDS Strategy (NHAS) includes specific progress indicators for improving the HIV care continuum, but the economic and epidemiological impact of achieving those indicators remains unclear.
We constructed a dynamic transmission model of HIV progression and care engagement to project HIV incidence, prevalence, mortality, and costs among adults in the United States over ten years. We specifically considered achievement of the 2020 targets set forth in NHAS progress indicator 1 (90% awareness of serostatus), indicator 4 (85% linkage within one month), and indicator 5 (90% of diagnosed individuals in care).
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. Achieving NHAS progress indicators 1 and 4 has modest epidemiologic impact (new infections reduced by 2·0% and 3·9%, respectively). By contrast, increasing the proportion of diagnosed individuals in care (indicator 5) averts 52% (47-56%) of new infections. Achieving all NHAS targets resulted in a 58% reduction (52%-61%) in new infections and 128,000 lives saved (106,000-223,000) at an incremental health system cost of $105 billion dollars.
Achievement of NHAS progress indicators for screening, linkage, and particularly improving retention in care, can substantially reduce the burden of HIV in the United States.
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