Modeling an Integrated HIV Prevention and Care Continuum to Achieve the Ending the HIV Epidemic Goals

Abstract

<jats:p>OBJECTIVE: We sought to evaluate which combinations of HIV prevention and care activities would have the greatest impact towards reaching the US Ending the HIV Epidemic (EHE) plan goals of reducing HIV incidence at least 75% by 2025 and 90% by 2030. DESIGN: A stochastic HIV transmission model for men who have sex with men (MSM), calibrated to local surveillance estimates in the Atlanta area, a focal EHE target jurisdiction. METHODS: Model scenarios varied HIV screening rates relative to current levels, under different assumptions of how HIV-negative MSM would be linked to PrEP initiation, and also considered improvements to HIV care linkage and retention for those screening positive. RESULTS: A 10-fold relative increase in HIV screening rates (to approximately biannual screening for black and Hispanic MSM and quarterly for white MSM) would lead to 43% of infections averted if integrated with PrEP initiation. Improvements to HIV care retention would avert 41% of infections if retention rates were improved 10-fold. If both screening and retention were jointly improved 10-fold, up to 74% of cumulative infections would be averted. Under this scenario, it would take 4 years to meet the 75% EHE goal and 12 years to meet the 90% goal for MSM in Atlanta. CONCLUSIONS: Interventions to improve HIV screening linked with PrEP for those screening negative, and HIV care retention would have a substantial impact on HIV prevention. However, additional interventions may be necessary to reach the EHE goal of a 90% reduction in incidence for Atlanta MSM by 2030.</jats:p>

Estimating the HIV Effective Reproduction Number in the United States and Evaluating HIV Elimination Strategies

“…38 Achieving these goals could result in a substantial reduction in the effective reproduction number in the United States. Jenness et al 39 used a network model of MSM in Atlanta with behavior and partnership parameters derived from the Web-based ARTnet study of MSM to demonstrate that HIV screening combined with PrEP linkage would provide major prevention benefits for MSM compared with screening not tied to PrEP. However, they noted that the cost of PrEP would be substantial to obtain these benefits.…”

A decision analytics model to optimize investment in interventions targeting the HIV preexposure prophylaxis cascade of care

“…Our network-based model of HIV transmission dynamics was built with the EpiModel platform [11]. Building on our previous models [12], this study implemented the mechanisms for increasing PrEP coverage through engagement in interventions. Full methodological details are provided in an Appendix (Supplemental Tables 1-13, http://links.lww.com/QAD/C101; Supplemental Figures 1-8, http://links.lww.com/QAD/C101), and full model code is available at http://github.com/EpiModel/ PrEP-Optimize.…”

Cost-Effectiveness of Interventions to Improve HIV Pre-exposure Prophylaxis Initiation, Adherence, and Persistence Among Men Who Have Sex With Men

“…We used EpiModel, a dynamic transmission model that has previously been described in detail, validated, and calibrated to fit sexual network, HIV care cascade, and PrEP cascade data for MSM in Atlanta (see Appendix S1-10, Supplemental Digital Content, http://links.lww.com/QAI/ B800). [13][14][15] EpiModel explicitly represents individual sexual acts within temporally evolving partnership networks, making it well-suited to modeling HIV transmission dynamics and prevention interventions. Parameter values were directly estimated from primary data or derived from published literature and calibrated to HIV surveillance data.…”