Data-Driven Goals for Curbing the U.S. HIV Epidemic by 2030

Abstract

Progress in reducing HIV infections has been suboptimal despite availability of effective prevention and treatment interventions and national strategies to bring them to scale. As part of a community-driven process, we expanded previous epidemiologic models using updated surveillance data from the Centers for Disease Control and Prevention to estimate quantitative parameters for ambitious but attainable national HIV prevention goals. We estimated new HIV infections could be reduced by up to 67% and prevalence could begin to decline by 2030 if 95% targets for diagnosis, care retention, and viral suppression are met by 2025 and an additional 20% of transmissions are averted through targeted interventions such as pre-exposure prophylaxis. Notably, this would require the percentage of diagnosed persons retained in HIV care to increase by more than 35 percentage points, which would necessitate innovative models and a substantial expansion of supportive services. Although the HIV incidence reduction goal of 90% as unveiled in the 2019 State of the Union Address is likely unachievable with the current intervention toolkit, it is possible to begin to substantially reduce HIV prevalence in the next decade with sufficient investments and innovation.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3

References

  1. 1.

    Centers for Disease Control and Prevention. HIV Surveill. Report. 2017;2018:29.

    Google Scholar 

  2. 2.

    Singh S, Song R, Johnson AS, McCray E, Hall HI. HIV incidence, prevalence, and undiagnosed infections in U.S. men who have sex with men. Ann Intern Med. 2018;168(10):685–94.

    Article  PubMed  Google Scholar 

  3. 3.

    Shah M, Perry A, Risher K, et al. Effect of the US National HIV/AIDS Strategy targets for improved HIV care engagement: a modelling study. Lancet HIV. 2016;3(3):e140–6.

    Article  PubMed  PubMed Central  Google Scholar 

  4. 4.

    Centers for Disease Control and Prevention and Association of Public Health Laboratories. Laboratory Testing for the Diagnosis of HIV Infection: Updated Recommendations 2014.

  5. 5.

    Bavinton BR, Pinto AN, Phanuphak N, et al. Viral suppression and HIV transmission in serodiscordant male couples: an international, prospective, observational, cohort study. Lancet HIV. 2018;5(8):e438–47.

    Article  PubMed  Google Scholar 

  6. 6.

    Cohen MS, Chen YQ, McCauley M, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365(6):493–505.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. 7.

    Rodger AJ, Cambiano V, Bruun T, et al. Sexual activity without condoms and risk of HIV transmission in serodifferent couples when the HIV-positive partner is using suppressive antiretroviral therapy. JAMA. 2016;316(2):171–81.

    Article  PubMed  Google Scholar 

  8. 8.

    Baeten JM, Donnell D, Ndase P, et al. Antiretroviral prophylaxis for HIV prevention in heterosexual men and women. N Engl J Med. 2012;367(5):399–410.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. 9.

    Grant RM, Lama JR, Anderson PL, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010;363(27):2587–99.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. 10.

    Gause NK, Brown JL, Welge J, Northern N. Meta-analyses of HIV prevention interventions targeting improved partner communication: effects on partner communication and condom use frequency outcomes. J Behav Med. 2018;41(4):423–40.

    Article  PubMed  Google Scholar 

  11. 11.

    Hergenrather KC, Emmanuel D, Durant S, Rhodes SD. Enhancing HIV prevention among young men who have sex with men: a systematic review of HIV behavioral interventions for young gay and bisexual men. AIDS Educ Prev. 2016;28(3):252–71.

    Article  PubMed  Google Scholar 

  12. 12.

    Laisaar KT, Raag M, Rosenthal M, Uuskula A. Behavioral interventions to reduce sexual risk behavior in adults with HIV/AIDS receiving HIV care: a systematic review. AIDS Patient Care STDS. 2015;29(5):288–98.

    Article  PubMed  PubMed Central  Google Scholar 

  13. 13.

    Perez A, Santamaria EK, Operario D. A systematic review of behavioral interventions to reduce condomless sex and increase HIV testing for Latino MSM. J Immigr Minor Health. 2018;20(5):1261–76.

    Article  PubMed  Google Scholar 

  14. 14.

    Smith DK, Herbst JH, Zhang X, Rose CE. Condom effectiveness for HIV prevention by consistency of use among men who have sex with men in the United States. J Acquir Immune Defic Syndr. 2015;68(3):337–44.

    Article  PubMed  Google Scholar 

  15. 15.

    Platt L, Minozzi S, Reed J, et al. Needle and syringe programmes and opioid substitution therapy for preventing HCV transmission among people who inject drugs: findings from a Cochrane Review and meta-analysis. Addiction. 2018;113(3):545–63.

    Article  PubMed  Google Scholar 

  16. 16.

    White House Office of National AIDS Policy. National HIV/AIDS Strategy for the United States 2010.

  17. 17.

    White House Office of National AIDS Policy. National HIV/AIDS Strategy for the United States: updated to 2020 2015.

  18. 18.

    Joint United Nations Programme on HIV/AIDS (UNAIDS). Fast-track: ending the AIDS epidemic by 2030. Geneva, Switzerland 2014.

  19. 19.

    National Alliance of State and Territorial AIDS Directors (NASTAD). Ending the HIV epidemic: jurisdictional plans. 2019; https://www.nastad.org/maps/ending-hiv-epidemic-jurisdictional-plans. Accessed February 10, 2019.

  20. 20.

    Bradley H, Althoff KN, Buchacz K, et al. Viral suppression among persons in HIV care in the United States during 2009–2013: sampling bias in Medical Monitoring Project surveillance estimates. Ann Epidemiol. 2018. https://doi.org/10.1016/j.annepidem.2018.11.005.

    Article  PubMed  Google Scholar 

  21. 21.

    Centers for Disease Control and Prevention. Estimated HIV incidence and prevalence in the United States, 20102015. 2018.

  22. 22.

    Fauci AS, Redfield RR, Sigounas G, Weahkee MD, Giroir BP. Ending the HIV epidemic: a plan for the United States. JAMA. 2019. https://doi.org/10.1001/jama.2019.1343.

    Article  PubMed  Google Scholar 

  23. 23.

    Bonacci RA, Holtgrave DRUSHIV. Incidence and transmission goals, 2020 and 2025. Am J Prev Med. 2017;53(3):275–81.

    Article  PubMed  Google Scholar 

  24. 24.

    Hall HI, Green TA, Wolitski RJ, et al. Estimated future HIV prevalence, incidence, and potential infections averted in the United States: a multiple scenario analysis. J Acquir Immune Defic Syndr. 2010;55(2):271–6.

    Article  PubMed  Google Scholar 

  25. 25.

    Skarbinski J, Rosenberg E, Paz-Bailey G, et al. Human immunodeficiency virus transmission at each step of the care continuum in the United States. JAMA Intern Med. 2015;175(4):588–96.

    Article  PubMed  Google Scholar 

  26. 26.

    Jenness SM, Goodreau SM, Rosenberg E, et al. Impact of the centers for disease control’s HIV preexposure prophylaxis guidelines for men who have sex with men in the United States. J Infect Dis. 2016;214(12):1800–7.

    Article  PubMed  PubMed Central  Google Scholar 

  27. 27.

    Sullivan PS, Giler RM, Mouhanna F, et al. Trends in the use of oral emtricitabine/tenofovir disoproxil fumarate for pre-exposure prophylaxis against HIV infection, United States, 2012–2017. Ann Epidemiol. 2018;28(12):833–40.

    Article  PubMed  Google Scholar 

  28. 28.

    Smith DK, Van Handel M, Grey J. Estimates of adults with indications for HIV pre-exposure prophylaxis by jurisdiction, transmission risk group, and race/ethnicity, United States, 2015. Ann Epidemiol. 2018;28(12):850–7.

    Article  PubMed  Google Scholar 

  29. 29.

    Bonacci RA, Holtgrave DR. Simplified estimates of HIV incidence and transmission rates for the USA, 2008-2012. AIDS. 2016;30(2):332–3.

    Article  PubMed  Google Scholar 

  30. 30.

    Centers for Disease Control and Prevention. Monitoring selected national HIV prevention and care objectives by using HIV surveillance data: United States and 6 dependent areas, 2016. HIV Surveill Suppl Rep. 2018;23(4):1065–72.

    Google Scholar 

  31. 31.

    Siegler AJ, Mouhanna F, Giler RM, et al. The prevalence of pre-exposure prophylaxis use and the pre-exposure prophylaxis-to-need ratio in the fourth quarter of 2017, United States. Ann Epidemiol. 2018;28(12):841–9.

    Article  PubMed  Google Scholar 

  32. 32.

    Centers for Disease Control and Prevention. Compendium of evidence-based interventions and best practices for HIV prevention: linkage to, retention in, and re-engagement in HIV Care (LRC) Chapter. 2019; https://www.cdc.gov/hiv/research/interventionresearch/compendium/lrc/index.html. Accessed February 11, 2019.

  33. 33.

    Craw J, Gardner L, Rossman A, et al. Structural factors and best practices in implementing a linkage to HIV care program using the ARTAS model. BMC Health Serv Res. 2010;10:246.

    Article  PubMed  PubMed Central  Google Scholar 

  34. 34.

    Higa DH, Crepaz N, Mullins MM, Prevention Research Synthesis Project. Identifying best practices for increasing linkage to, retention, and re-engagement in HIV medical care: findings from a systematic review, 1996–2014. AIDS Behav. 2015;24:951–66.

    Google Scholar 

  35. 35.

    Mizuno Y, Higa DH, Leighton CA, Roland KB, Deluca JB, Koenig LJ. Is HIV patient navigation associated with HIV care continuum outcomes? AIDS. 2018;32(17):2557–71.

    PubMed  Google Scholar 

  36. 36.

    Jain KM, Maulsby C, Kinsky S, Charles V, Holtgrave DR, Team PCI. 2015–2020 national HIV/AIDS strategy goals for HIV linkage and retention in care: recommendations from program implementers. Am J Public Health. 2016;106(3):399–401.

    Article  PubMed  PubMed Central  Google Scholar 

  37. 37.

    Maulsby C, Sacamano P, Jain KM, et al. Barriers and facilitators to the implementation of a national HIV linkage, re-engagement, and retention in care program. AIDS Educ Prev. 2017;29(5):443–56.

    Article  PubMed  PubMed Central  Google Scholar 

  38. 38.

    Tucker JD, Tso LS, Hall B, et al. Enhancing public health HIV interventions: a qualitative meta-synthesis and systematic review of studies to improve linkage to care, adherence, and retention. EBioMedicine. 2017;17:163–71.

    Article  PubMed  PubMed Central  Google Scholar 

  39. 39.

    Bradley H, Viall AH, Wortley PM, Dempsey A, Hauck H, Skarbinski J. Ryan white HIV/AIDS program assistance and HIV treatment outcomes. Clin Infect Dis. 2016;62(1):90–8.

    Article  PubMed  Google Scholar 

  40. 40.

    Weiser J, Beer L, Frazier EL, et al. Service delivery and patient outcomes in Ryan White HIV/AIDS program-funded and -nonfunded health care facilities in the United States. JAMA Intern Med. 2015;175(10):1650–9.

    Article  PubMed  PubMed Central  Google Scholar 

  41. 41.

    AIDS United. Ending the HIV epidemic in the United States: a roadmap for federal action 2018.

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Heather Bradley.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Bradley, H., Rosenberg, E.S. & Holtgrave, D.R. Data-Driven Goals for Curbing the U.S. HIV Epidemic by 2030. AIDS Behav 23, 557–563 (2019). https://doi.org/10.1007/s10461-019-02442-7

Download citation

Keywords

  • Surveillance
  • HIV care continuum
  • HIV incidence
  • HIV prevalence