The Impact of Implementing a Test, Treat and Retain HIV Prevention Strategy in Atlanta among Black Men Who Have Sex with Men with a History of Incarceration: A Mathematical Model

• Type of Material: Article
• Authors: Viviane D. Lima, University of British Columbia; Isabell Graf, Simon Fraser University; Curt G. Beckwith, Brown University; Sandra Springer, Yale University; Frederick L. Altice, Yale University; Daniel Coombs, University of British Columbia; Brian Kim, Emory University; Lauren Messina, Emory University; Julio S. G. Montaner, University of British Columbia; Anne Spaulding, Emory University
• Language: English
• Date: 2015-04-23
• Publisher: Public Library of Science
• Publication Version: Final Published Version
• Copyright Statement: © 2015 Lima et al.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1371/journal.pone.0123482
• Title of Journal or Parent Work: PLoS ONE
• ISSN: 1932-6203
• Volume: 10
• Issue: 4
• Start Page: e0123482
• End Page: e0123482
• Grant/Funding Information: In addition, VDL is supported by a grant from the US National Institute on Drug Abuse (R03 DA033851), a grant from the Canadian Institutes of Health Research (CIHR; MOP-125948), by a Scholar Award from the Michael Institute for Health Research and a New Investigator award from CIHR.; CB, SS, AS, FA, VDL and JM received grant supplements through the National Institute of Drug Abuse for the Criminal Justice Modeling Project.; JM is supported with grants paid to his institution by the British Columbia Ministry of Health and by the US National Institutes of Health (R01 DA036307).; FA is supported through different grants from the US National Institute of Drug Abuse (R01 DA025943, R01 DA029910, R01 DA033679, R01 DA030762 and K24 DA017072).; The parent grants for these supplements were R01 DA021525, R01 DA27211 and R01 DA030768.; AS is supported through a grant from the National Institute of Allergy and Infectious Diseases through the Emory Center for AIDS Research (P30 AI050409).
• Keywords: UNITED-STATES; HIGH PREVALENCE; Death rates; Ethnic epidemiology; UNDIAGNOSED HIV; Science & Technology; Science & Technology - Other Topics; Public and occupational health; HIV prevention; INFECTED PRISONERS; CARE; RISK; HIV; PUBLIC-HEALTH; Multidisciplinary Sciences; Prisons; ACTIVE ANTIRETROVIRAL THERAPY; HIV epidemiology; HIV infections; HOMOSEXUAL-MEN; ANAL INTERCOURSE
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Public Health

Abstract

Background: Annually, 10 million adults transition through prisons or jails in the United States (US) and the prevalence of HIV among entrants is three times higher than that for the country as a whole. We assessed the potential impact of increasing HIV Testing/Treatment/Retention (HIV-TTR) in the community and within the criminal justice system (CJS) facilities, coupled with sexual risk behavior change, focusing on black men-who-have-sex-with-men, 15-54 years, in Atlanta, USA. Methods: We modeled the effect of a HIV-TTR strategy on the estimated cumulative number of new (acquired) infections and mortality, and on the HIV prevalence at the end of ten years. We additionally assessed the effect of increasing condom use in all settings. Results: In the Status Quo scenario, at the end of 10 years, the cumulative number of new infections in the community, jail and prison was, respectively, 9246, 77 and 154 cases; HIV prevalence was 10815, 69 and 152 cases, respectively; and the cumulative number of deaths was 2585, 18 and 34 cases, respectively. By increasing HIV-TTR coverage, the cumulative number of new infections could decrease by 15% in the community, 19% in jail, and 8% in prison; HIV prevalence could decrease by 8%, 9% and 7%, respectively; mortality could decrease by 20%, 39% and 18%, respectively. Based on the model results, we have shown that limited use and access to condoms have contributed to the HIV incidence and prevalence in all settings. Conclusions: Aggressive implementation of a CJS-focused HIV-TTR strategy has the potential to interrupt HIV transmission and reduce mortality, with benefit to the community at large. To maximize the impact of these interventions, retention in treatment, including during the period after jail and prison release, and increased condom use was vital for decreasing the burden of the HIV epidemic in all settings.