Retaining people with HIV in care and treatment for the virus, as well as successful efforts to re-engage patients who have been in care but no longer are would go the furthest toward cutting the numbers of new infections in the United States in half within the next decade, a modeling study reported in Open Forum Infectious Diseases finds. The study’s data and calculations are limited to U.S. numbers but its findings, which include needs to strengthen testing and care linkage as well as prevention efforts as well, reflect global challenges.
While antiretroviral treatments for HIV have improved over the last two decades and been proven to prevent transmission of the virus, the authors note, incidence rates have been slow to decline, with an estimated 36,000 to 39,000 people being infected each year. Citing estimates that less than half of the estimated 1.1 million people living with the virus remain in care, which is critical to suppressing the virus and lowering risks of transmission, the authors calculate that 375,000 people could be expected to be infected, and 225,000 people with the virus will die between 2016 and 2025 if retention rates don’t improve.
Care retention and re-engagement efforts would have to succeed in keeping 95 percent of patients in care, and returning those out of care within a year and a half to achieve the goal of HIV incidence in half, the authors write. Current challenges in health access and meeting patient needs could put that target out of reach, they write, and annual screenings and more efficient and effective links to care as well as to prevention measures that include pre-exposure prophylactic use of antiretroviral medicines — or PrEP — also are critical.
The study was led by Allison Perry of Johns Hopkins Bloomberg School of Public Health.