If the United States were to reach targets for HIV testing and treatment by 2020, the impact, measured by lives saved and new infections prevented over the next 20 years, would be massive.
A new study in The Journal of Infectious Diseases finds that achieving these goals would:
“This analysis demonstrates that we have it in our power, and even within our economic reach, to stop the HIV/AIDS epidemic in the United States,” said study author Dr. Rochelle P. Walensky of Massachusetts General Hospital and Harvard Medical School. “The strategy to once-and-for-all tackle the HIV epidemic in the United States is both of excellent economic value and affordable.”
The researchers used a mathematical simulation to project the long-term clinical outcomes, costs, and cost-effectiveness of reaching nationwide targets for the U.S. response to HIV by 2020, as set out in the U.S. National HIV/AIDS Strategy. Released by the federal government in 2010 and revised in 2015, the strategy’s goals include a target of 90 percent for the proportion of people in the United States with HIV who know they are infected. Among those diagnosed with HIV infection, the strategy also calls for at least 80 percent to have a viral load that is suppressed by antiretroviral drugs. These goals, if achieved, would mean that 72 percent of people living with HIV have fully suppressed virus, much higher than the current U.S. estimate of 49 percent.
The study’s findings suggest that reaching these targets by 2020 — and sustaining them into the future — would yield major clinical and economic benefits over the next 20 years. The impact would be particularly striking and extraordinarily cost-effective, the analysis found, in black men who have sex with men, a population hard hit by the HIV epidemic who account for more HIV diagnoses in the United States than any other group, according to the Centers for Disease Control and Prevention (CDC). Achieving these goals, however, will require new, culturally grounded, and non-stigmatizing strategies that address barriers that have to date limited access to HIV testing and treatment in this key population and others, the researchers noted.
“We show for the first time that the most efficient, most cost-effective priority target for HIV prevention, screening and treatment in the United States islack men who have sex with men,” said Dr. A. David Paltiel, a co-author of the study and a professor at the Yale School of Public Health. “This is the population that endures the most disproportionate burden of the HIV epidemic but is often the hardest to engage and to retain in care.”
To cover the costs of reaching the treatment goals outlined in the National HIV/AIDS Strategy and maintaining them, the study finds that the federal HIV budget would need to grow 23 percent — or by approximately 5 percent per year — over the next 20 years. Seventy-five percent of the additional spending would be for antiretroviral drugs, the analysis found, which now cost approximately $40,000 per person, per year. “If drug costs could be reduced by just a third, you could use just those savings alone to pay for this strategy,” said the study’s first author, Mr. Ethan D. Borre of the Medical Practice Evaluation Center at Massachusetts General Hospital.