What Will It Take to End HIV in the United States? : A Comprehensive, Local-Level Modeling Study.
Journal
Annals of internal medicine
ISSN: 1539-3704
Titre abrégé: Ann Intern Med
Pays: United States
ID NLM: 0372351
Informations de publication
Date de publication:
11 2021
11 2021
Historique:
pubmed:
21
9
2021
medline:
25
11
2021
entrez:
20
9
2021
Statut:
ppublish
Résumé
The Ending the HIV Epidemic (EHE) initiative aims to reduce incident HIV infections by 90% over a span of 10 years. The intensity of interventions needed to achieve this for local epidemics is unclear. To estimate the effect of HIV interventions at the city level. A compartmental model of city-level HIV transmission stratified by age, race, sex, and HIV risk factor was developed and calibrated. 32 priority metropolitan statistical areas (MSAs). Simulated populations in each MSA. Combinations of HIV testing and preexposure prophylaxis (PrEP) coverage among those at risk for HIV, plus viral suppression in persons with diagnosed HIV infection. The primary outcome was the projected reduction in incident cases from 2020 to 2030. Absent intervention, HIV incidence was projected to decrease by 19% across all 32 MSAs. Modest increases in testing (1.25-fold per year), PrEP coverage (5 percentage points), and viral suppression (10 percentage points) across the population could achieve reductions of 34% to 67% by 2030. Twenty-five percent PrEP coverage, testing twice a year on average, and 90% viral suppression among young Black and Hispanic men who have sex with men (MSM) achieved similar reductions (13% to 68%). Including all MSM and persons who inject drugs could reduce incidence by 48% to 90%. Thirteen of 32 MSAs could achieve greater than 90% reductions in HIV incidence with large-scale interventions that include heterosexuals. A web application with location-specific results is publicly available (www.jheem.org). The COVID-19 pandemic was not represented. Large reductions in HIV incidence are achievable with substantial investment, but the EHE goals will be difficult to achieve in most locations. An interactive model that can help policymakers maximize the effect in their local environments is presented. National Institutes of Health.
Sections du résumé
BACKGROUND
The Ending the HIV Epidemic (EHE) initiative aims to reduce incident HIV infections by 90% over a span of 10 years. The intensity of interventions needed to achieve this for local epidemics is unclear.
OBJECTIVE
To estimate the effect of HIV interventions at the city level.
DESIGN
A compartmental model of city-level HIV transmission stratified by age, race, sex, and HIV risk factor was developed and calibrated.
SETTING
32 priority metropolitan statistical areas (MSAs).
PATIENTS
Simulated populations in each MSA.
INTERVENTION
Combinations of HIV testing and preexposure prophylaxis (PrEP) coverage among those at risk for HIV, plus viral suppression in persons with diagnosed HIV infection.
MEASUREMENTS
The primary outcome was the projected reduction in incident cases from 2020 to 2030.
RESULTS
Absent intervention, HIV incidence was projected to decrease by 19% across all 32 MSAs. Modest increases in testing (1.25-fold per year), PrEP coverage (5 percentage points), and viral suppression (10 percentage points) across the population could achieve reductions of 34% to 67% by 2030. Twenty-five percent PrEP coverage, testing twice a year on average, and 90% viral suppression among young Black and Hispanic men who have sex with men (MSM) achieved similar reductions (13% to 68%). Including all MSM and persons who inject drugs could reduce incidence by 48% to 90%. Thirteen of 32 MSAs could achieve greater than 90% reductions in HIV incidence with large-scale interventions that include heterosexuals. A web application with location-specific results is publicly available (www.jheem.org).
LIMITATION
The COVID-19 pandemic was not represented.
CONCLUSION
Large reductions in HIV incidence are achievable with substantial investment, but the EHE goals will be difficult to achieve in most locations. An interactive model that can help policymakers maximize the effect in their local environments is presented.
PRIMARY FUNDING SOURCE
National Institutes of Health.
Identifiants
pubmed: 34543589
doi: 10.7326/M21-1501
pmc: PMC8595759
mid: NIHMS1744246
doi:
Substances chimiques
Anti-HIV Agents
0
Types de publication
Journal Article
Video-Audio Media
Langues
eng
Sous-ensembles de citation
IM
Pagination
1542-1553Subventions
Organisme : NIAID NIH HHS
ID : K01 AI138853
Pays : United States
Organisme : NIMH NIH HHS
ID : K08 MH118094
Pays : United States
Organisme : NIAID NIH HHS
ID : P30 AI094189
Pays : United States
Organisme : NHLBI NIH HHS
ID : T32 HL007024
Pays : United States
Commentaires et corrections
Type : CommentIn
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