Optimizing HIV Prevention Efforts to Achieve EHE Incidence Targets

Abstract

Background: A goal of the US Department of Health and Human Services' Ending the HIV Epidemic (EHE) in the United States initiative is to reduce the annual number of incident HIV infections in the United States by 75% within 5 years and by 90% within 10 years. We developed a resource allocation analysis to understand how these goals might be met. Methods:We estimated the current annual societal funding [$2.8 billion (B)/yr] for 14 interventions to prevent HIV and facilitate treatment of infected persons. These interventions included HIV testing for different transmission groups, HIV care continuum interventions, pre-exposure prophylaxis, and syringe services programs. We developed scenarios optimizing or reallocating this funding to minimize new infections, and we analyzed the impact of additional EHE funding over the period 2021-2030.Results: With constant current annual societal funding of $2.8 B/yr for 10 years starting in 2021, we estimated the annual incidence of 36,000 new cases in 2030. When we added annual EHE funding of $500 million (M)/yr for 2021-2022, $1.5 B/yr for 2023-2025, and $2.5 B/yr for 2026-2030, the annual incidence of infections decreased to 7600 cases (no optimization), 2900 cases (optimization beginning in 2026), and 2200 cases (optimization beginning in 2023) in 2030.Conclusions: Even without optimization, significant increases in resources could lead to an 80% decrease in the annual HIV incidence in 10 years. However, to reach both EHE targets, optimization of prevention funding early in the EHE period is necessary. Implementing these efficient allocations would require flexibility of funding across agencies, which might be difficult to achieve.

Assessing the Impact of COVID-19 on HIV Outcomes in the United States: A Modeling Study

“…Even before considering the effects of COVID-19, reaching this goal would require significant effort and investment. 25 Continued efforts to increase HIV prevention and care to offset any COVID-19 pandemic-related setbacks are important and necessary. 26 As our results suggest, the effect of changes to HIV care and prevention efforts can last for several years.…”

“…Although a possible pandemic-related 2% increase in incidence in 2022 to 2024 is important to note and incorporate in programmatic and funding decisions, it may be relatively negligible as we are working toward the EHE goal of 90% reduction in HIV incidence by 2030. Even before considering the effects of COVID-19, reaching this goal would require significant effort and investment 25 …”

“…Further details, including information regarding model calibration, validation, and sensitivity/uncertainty analyses, have been previously published and are also provided in the technical report. 25 We used the HOPE model to simulate the effects of the COVID-19 pandemic on factors affecting HIV transmission in the United States. 6,8,9,12,13 The model is initialized in the year 2010 and run for several years to reduce the dependence of model behavior on initial conditions during the study period.…”

“…The calibration procedure allows parameters to vary within acceptable ranges informed by literature values and is terminated when the surveillance targets are within acceptable levels. Further details, including information regarding model calibration, validation, and sensitivity/uncertainty analyses, have been previously published and are also provided in the technical report 25 …”

U.S. Black Women and Human Immunodeficiency Virus Preexposure Prophylaxis Implementation

“…9 To achieve the Ending the HIV Epidemic in the U.S. initiative goal of reducing HIV incidence at least 90% by 2030, at least 50% of persons with PrEP indications should be prescribed PrEP by 2025. 10 However, women lag far behind this 50% PrEP goal. By the end of 2020, only 10.4% of women with PrEP indications were prescribed PrEP compared with 28.0% of men.…”