Identifying Regions of Greatest Need for Ending the HIV Epidemic

A Plan for America

Mia Moore, PhD; Marie-Claude Boily, PhD; Kate M. Mitchell, PhD; Deborah D. Donnell, PhD; Myron S. Cohen, MD; Dobromir T. Dimitrov, PhD

Disclosures

J Acquir Immune Defic Syndr. 2020;85(4):395-398. 

In This Article

Abstract and Introduction

Abstract

Background: In the 2019 State of the Union Address, President Trump announced a plan for "Ending the HIV Epidemic" in the United States, with a goal to reduce new HIV infections by 90% by 2030. Phase I of the plan set an intermediate goal of a 75% reduction within 5 years, focusing on select states and counties.

Methods: We assessed the feasibility of the first phase of the plan by estimating the fraction of HIV diagnoses that occur within the targeted region, using a statistical model to predict new HIV cases in each county. We suggested new areas that should be added to the current plan, prioritizing by both a "Density Metric" of new HIV cases and a "Gap Metric" quantifying shortcomings in antiretroviral therapy and pre-exposure prophylaxis uptake.

Results: We found the current plan targets less than 60% of new diagnoses. The plan should be expanded to Puerto Rico, Florida, Georgia, Louisiana, and Maryland as well as parts of New York, North Carolina, Texas, and Virginia, areas which were prioritized by both metrics.

Conclusion: Many of the highest priority areas, both by density of HIV cases and by lack of viral suppression and pre-exposure prophylaxis use, were not covered by the original plan, particularly in the South. The current plan to end the HIV epidemic must be expanded to these areas to feasibly allow for a 75% reduction in new HIV cases within 5 years.

Introduction

In the 2019 State of the Union Address, President Trump announced an ambitious Ending the HIV Epidemic (EHE) plan seeking "to reduce the number of new HIV infections in the United States by 75 percent within 5 years, and then by at least 90 percent within 10 years, for an estimated 250,000 total HIV infections averted"[1] by improving HIV testing and treatment, better utilization of pre-exposure prophylaxis (PrEP) among at-risk populations, and quick responses to HIV outbreaks.[2,3] The first phase of the plan, lasting 5 years, will focus on the 48 counties with the most new HIV cases plus San Juan, Puerto Rico, and Washington, DC, where more than 50% of new HIV diagnoses occurred in 2016 and 2017, as well as 7 states with a large number of diagnoses in rural areas.

We performed a predictive statistical analysis to assess if the program is likely to achieve its goal of reducing new HIV infections by 75% in 5 years or if it needs to be expanded to cover additional areas. Our analysis suggests that (1) as the areas included in the first phase of the plan account for less than 60% of new HIV diagnoses, even a complete elimination of HIV transmission in those areas will be insufficient to achieve a 75% reduction in overall HIV transmission and (2) targeting counties based solely on absolute numbers of HIV diagnoses excludes some of the areas with the highest density of new diagnoses, particularly in the South, which are also most in need of improving their HIV care services.

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