Achieving the "Ending the HIV Epidemic in the US" incidence reduction goals among at-risk populations in the South

• Type of Material: Article
• Authors: Deven T Hamilton, University of Washington; Karen W Hoover, Centers for Disease Control and Prevention (CDC), Atlanta; Dawn K Smith, Centers for Disease Control and Prevention (CDC), Atlanta; Kevin P Delaney, Centers for Disease Control and Prevention (CDC), Atlanta; Li Yan Wang, Centers for Disease Control and Prevention, Atlanta; Jungjing Li, Centers for Disease Control and Prevention, Atlanta; Tamika Hoyte, Ctr Dis Control & Prevent CDC; Samuel Jenness, Emory University; Samuel M Goodreau, University of Washington
• Language: English
• Date: 2023-04-20
• Publisher: BMC
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2023
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1186/s12889-023-15563-5
• Title of Journal or Parent Work: BMC PUBLIC HEALTH
• Volume: 23
• Issue: 1
• Start Page: 716
• End Page: 716
• Grant/Funding Information: We received additional support from the Center for Studies in Demography and Ecology (NIH P2C HD042828) at the University of Washington and NIH grant R21 MH112449.; This work was supported by the CDC/NCHHSTP Epidemiological and Economic Modeling Agreement (NEEMA) (U38 PS004650).
• Keywords: SERVICES; Antiretroviral therapy; Life Sciences & Biomedicine; UNITED-STATES; Public, Environmental & Occupational Health; HUMAN-IMMUNODEFICIENCY-VIRUS; Pre-exposure prophylaxis; HIV; CONTINUUM; CARE; IMPACT; TRANSMISSION; PREEXPOSURE PROPHYLAXIS; COVID-19; PREVENTION; Modeling; Science & Technology
• Research Categories: Health Sciences, Public Health; Health Sciences, Epidemiology; Biology, Ecology; Anthropology, Physical

Abstract

Introduction: Antiretroviral medication coverage remains sub-optimal in much of the United States, particularly the Sothern region, and Non-Hispanic Black or African American persons (NHB) continue to be disproportionately impacted by the HIV epidemic. The “Ending the HIV Epidemic in the U.S.” (EHE) initiative seeks to reduce HIV incidence nationally by focusing resources towards the most highly impacted localities and populations. This study evaluates the impact of hypothetical improvements in ART and PrEP coverage to estimate the levels of coverage needed to achieve EHE goals in the South. Methods: We developed a stochastic, agent-based network model of 500,000 individuals to simulate the HIV epidemic and hypothetical improvements in ART and PrEP coverage. Results: New infections declined by 78.6% at 90%/40% ART/PrEP and 94.3% at 100%/50% ART/PrEP. Declines in annual incidence rates surpassed 75% by 2025 with 90%/40% ART/PrEP and 90% by 2030 with 100%/50% ART/PrEP coverage. Increased ART coverage among NHB MSM was associated with a linear decline in incidence among all MSM. Declines in incidence among Hispanic/Latino and White/Other MSM were similar regardless of which MSM race group increased their ART coverage, while the benefit to NHB MSM was greatest when their own ART coverage increased. The incidence rate among NHB women declined by over a third when either NHB heterosexual men or NHB MSM increased their ART use respectively. Increased use of PrEP was associated with a decline in incidence for the groups using PrEP. MSM experienced the largest absolute declines in incidence with increasing PrEP coverage, followed by NHB women. Conclusions: Our analysis indicates that it is possible to reach EHE goals. The largest reductions in HIV incidence can be achieved by increasing ART coverage among MSM and all race groups benefit regardless of differences in ART initiation by race. Improving ART coverage to > 90% should be prioritized with a particular emphasis on reaching NHB MSM. Such a focus will reduce the largest number of incident cases, reduce racial HIV incidence disparities among both MSM and women, and reduce racial health disparities among persons with HIV. NHB women should also be prioritized for PrEP outreach.