Progression and Transmission of HIV/AIDS (PATH 2.0)

Gopalappa, Chaitra; Farnham, Paul G.; Chen, Yao-Hsuan; Sansom, Stephanie L.

doi:10.1177/0272989x16668509

Cited by 59 publications

(36 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…CDC updated the Progression and Transmission of HIV (PATH 2.0) model to estimate 2016 U.S. transmission rates by step along the HIV care continuum, population risk group, and age group ( 9 ). Mutually exclusive population risk groups included 1) men who have sex with men (MSM), 2) persons who inject drugs (men and women), 3) MSM who inject drugs, and 4) heterosexual men and women.…”

Section: Methodsmentioning

confidence: 99%

“…In 2015, among all persons with HIV infection, 14.5% did not have a diagnosis, 37.2% were not in care,* and 48.9% were not virally suppressed ( 7 ). In addition, sexual and injection-drug–associated risk behaviors varied with knowledge of HIV infection status and access to care ( 9 , 10 ). Lack of effective treatment results in worse outcomes for persons with HIV infection and higher rates of HIV transmission and was associated with 38,700 new HIV infections in 2016 ( 8 ).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Vital Signs:HIV Transmission Along the Continuum of Care — United States, 2016

Purcell

Sansom

et al. 2019

MMWR Morb. Mortal. Wkly. Rep.

Self Cite

227

176

View full text Add to dashboard Cite

Background In 2016, an estimated 1.1 million persons had human immunodeficiency virus (HIV) infection in the United States; 38,700 were new infections. Knowledge of HIV infection status, behavior change, and antiretroviral therapy (ART) all prevent HIV transmission. Persons who achieve and maintain viral suppression (achieved by most persons within 6 months of starting ART) can live long, healthy lives and pose effectively no risk of HIV transmission to their sexual partners. Methods A model was used to estimate transmission rates in 2016 along the HIV continuum of care. Data for sexual and needle-sharing behaviors were obtained from National HIV Behavioral Surveillance. Estimated HIV prevalence, incidence, receipt of care, and viral suppression were obtained from National HIV Surveillance System data. Results Overall, the HIV transmission rate was 3.5 per 100 person-years in 2016. Along the HIV continuum of care, the transmission rates from persons who were 1) acutely infected and unaware of their infection, 2) non-acutely infected and unaware, 3) aware of HIV infection but not in care, 4) receiving HIV care but not virally suppressed, and 5) taking ART and virally suppressed were 16.1, 8.4, 6.6, 6.1, and 0 per 100 person-years, respectively. The percentages of all transmissions generated by each group were 4.0%, 33.6%, 42.6%, 19.8%, and 0%, respectively. Conclusion Approximately 80% of new HIV transmissions are from persons who do not know they have HIV infection or are not receiving regular care. Going forward, increasing the percentage of persons with HIV infection who have achieved viral suppression and do not transmit HIV will be critical for ending the HIV epidemic in the United States.

show abstract

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Vital Signs:HIV Transmission Along the Continuum of Care — United States, 2016

Purcell

Sansom

et al. 2019

MMWR Morb. Mortal. Wkly. Rep.

Self Cite

227

176

View full text Add to dashboard Cite

show abstract

“…Understanding the prevalence of risky sex practices among MLWH along the HIV care continuum can directly inform the development of tailored HIV prevention efforts. Additionally, current research indicates that MSM who also have sex with women (MSMW) may potentially contribute substantially to HIV transmission among heterosexual women [13–15]. Better understanding of both the prevalence and characteristics of sex with female partners is needed to inform the limited body of literature on this topic and potential interventions.…”

Section: Introductionmentioning

confidence: 99%

Sex Practices by HIV Awareness and Engagement in the Continuum of Care Among MSM: A National HIV Behavioral Surveillance Analysis in 21 U.S. Cities

Team

2017

AIDS Behav

Self Cite

View full text Add to dashboard Cite

Using National HIV Behavioral Surveillance (NHBS) cross-sectional survey and HIV testing data in 21 U.S. metropolitan areas, we identify sex practices among sexually active men who have sex with men (MSM) associated with: (1) awareness of HIV status, and (2) engagement in the HIV care continuum. Data from 2008, 2011, and 2014 were aggregated, yielding a sample of 5079 sexually active MSM living with HIV (MLWH). Participants were classified into HIV status categories: (1) unaware; (2) aware and out of care; (3) aware and in care without antiretroviral therapy (ART); and (4) aware and on ART. Analyses were conducted examining sex practices (e.g. condomless sex, discordant condomless sex, and number of sex partners) by HIV status. Approximately 30, 5, 10 and 55% of the sample was classified as unaware, aware and out of care, aware and in care without ART, and aware and on ART, respectively. Unaware MLWH were more likely to report condomless anal sex with a last male partner of discordant or unknown HIV status (25.9%) than aware MLWH (18.0%, p value< 0.0001). Unaware MLWH were 3 times as likely to report a female sex partner in the prior 12 months as aware MLWH (17.3 and 5.6%, p-value < 0.0001). When examining trends across the continuum of care, reports of any condomless anal sex with a male partner in the past year (ranging from 65.0 to 70.0%), condomless anal sex with a male partner of discordant or unknown HIV status (ranging from 17.7 to 21.3%), and median number of both male and female sex partners were similar. In conclusion, awareness of HIV and engagement in care was not consistently associated with protective sex practices, highlighting the need for continued prevention efforts.

show abstract

“…This could have resulted in smaller or larger transmission rates for MSM and heterosexuals because we do not know how many transmissions in these groups resulted from sexual mixing with persons who inject drugs. In addition, PATH 2.0’s transmission modeling technique of building partnerships of HIV-infected persons over time, unlike traditional individual-based techniques of modeling all infected and uninfected persons, is subject to a small margin of error (7). As in any model, due to the dynamic nature of infectious diseases, the impacts of the same strategy could vary over time as the baseline values change.…”

Section: Discussionmentioning

confidence: 99%

Combinations of interventions to achieve a national HIV incidence reduction goal

Gopalappa

Sansom

Farnham

et al. 2017

Aids

Self Cite

View full text Add to dashboard Cite

Objective Analyzing HIV care service targets for achieving a national goal of a 25% reduction in annual HIV incidence and evaluating the use of annual HIV diagnoses to measure progress in incidence reduction. Design Because there are considerable interactions among HIV care services, we model the dynamics of combinations of increases in HIV care continuum targets to identify those that would achieve 25% reductions in annual incidence and diagnoses. Methods We used Progression and Transmission of HIV/AIDS (PATH 2.0), an agent-based dynamic stochastic simulation of HIV in the United States. Results A 25% reduction in annual incidence could be achieved by multiple alternative combinations of percentages of persons with diagnosed infection and persons with viral suppression including 85% and 68%, respectively, and 90% and 59%, respectively. The first combination corresponded to an 18% reduction in annual diagnoses, and infections being diagnosed at a median CD4 count of 372 cells/μL or approximately 3.8 years from time of infection. The corresponding values on the second combination are 4%, 462 cells/μL, and 2.0 years, respectively. Conclusions Our analysis provides policy makers with specific targets and alternative choices to achieve the goal of a 25% reduction in HIV incidence. Reducing annual diagnoses does not equate to reducing annual incidence. Instead, progress toward reducing incidence can be measured by monitoring HIV surveillance data trends in CD4 count at diagnosis along with the proportion who have achieved viral suppression to determine where to focus local programmatic efforts.

show abstract

Progression and Transmission of HIV/AIDS (PATH 2.0)

Abstract: The model results support a continued focus on early diagnosis, treatment and adherence to ART, with an emphasis on prevention efforts for MSM, a subgroup of whom appear to play a role in transmission to heterosexuals.

Cited by 59 publications

References 31 publications

Vital Signs:HIV Transmission Along the Continuum of Care — United States, 2016

Vital Signs:HIV Transmission Along the Continuum of Care — United States, 2016

Sex Practices by HIV Awareness and Engagement in the Continuum of Care Among MSM: A National HIV Behavioral Surveillance Analysis in 21 U.S. Cities

Combinations of interventions to achieve a national HIV incidence reduction goal

Contact Info

Product

Resources

About