HIV
HIV
Evaluating SSP and MAT Program Coverage Needed to Reduce HIV and HCV Infections in the U.S.
Persons who inject drugs (PWID) are at high risk for multiple bloodborne and sexually transmitted infections, including hepatitis C virus (HCV) and HIV. National and state-level planning for syringe service programs (SSP) and medication for opioid use disorder (MOUD) relies on the accurate estimation of PWID population size and requires an understanding of how these interventions impact HCV and HIV transmission, in addition to other bloodborne infections. The structure of injection and sexual networks among PWID leads to heterogeneous risks of infection transmission and acquisition. In addition to SSPs and MOUD, many other preventive strategies are available for both HCV and HIV, including biomedical interventions, such as HIV pre-exposure prophylaxis, HIV treatment, HCV treatment, and behavioral interventions, such as promoting safer injection practices and condom use. Interventions can interact and generate synergistic effects on the prevention of HCV and HIV. What determines the optimal intervention package is unknown.
This project extends PPML’s existing agent-based network model of HCV transmission among PWID by adding the sexual partnership network and transmission dynamics of HIV and other sexually transmitted infections to the existing network of equipment-sharing, to:
- Determine the levels of SSP coverage needed to reduce new HIV and HCV infections among PWID by 25%, 50%, and 90%
- Compare the population health and economic impacts of different levels of program coverage for opioid use disorder
- Identify intervention combinations among the different prevention strategies that may produce substantial reductions in HCV and HIV burden among PWID
- Compare the cost-effectiveness of different intervention packages
Further expansion of this work integrates detailed clinical and program data from Massachusetts into the agent-based multiplex model and provides insight into specific questions through a partnership with the Massachusetts Department of Public Health.
Estimation of PrEP Need Among Demographic Strata
Awareness of PrEP for HIV and knowledge of its effectiveness have increased in recent years. PrEP is recommended for people at high risk of HIV acquisition and is a crucial component in the Ending the HIV Epidemic in the U.S. (EHE) Initiative. To develop more accurate PrEP coverage indicators, an estimate is needed to quantify the population who can benefit from PrEP. Given advances in PrEP use for HIV prevention, the current definition of PrEP need may be too restrictive.
This project re-evaluates the population size of people who could benefit from PrEP and develops a revised metric for PrEP need in the United States.
Estimating the Annual Number of HIV Tests Conducted and HIV Testing Targets in the United States
HIV testing is an integral component of the Ending the HIV Epidemic in the U.S. (EHE) Initiative, specifically the Diagnose pillar. Estimating and evaluating the reach of HIV testing efforts allows national, state, and local partners to make informed decisions to improve access and reach of HIV testing.
The overall aim of the project is to summarize key HIV measures with a focus on testing needs and uptake, including coverage of HIV testing over time, HIV tests performed annually in the U.S., and people who should be tested for HIV following CDC recommendations.
Past Project
School-Age and Young Adult Testing for HIV: Cost-Effectiveness Analysis to Inform Guidelines
In 2006, the CDC recommended routine HIV testing for adolescents and adults, ages 13 to 64, in the United States. These recommendations were based on several factors and studies, including the overall and undiagnosed prevalence of HIV in the United States, the availability, accuracy, rapidity, and low cost of the HIV test, and the availability of highly effective and life-saving therapies for HIV. Model-based analyses suggested that routine HIV testing would be very cost-effective, although these analyses did not include adolescents specifically.
The current CDC recommendations are based on a model using case surveillance among those age 13 and over. While the recommendations imply that it is worthwhile to get tested at least once in a lifetime, this recommendation is difficult to interpret early in the life course. National data highlight that HIV prevalence varies across age groups and is much lower in teens than young and older adults. For these reasons, there is an important need to further refine the lower end of the age range for HIV testing guidelines.
This project examined the yield, cost, and cost-effectiveness of routine HIV testing in school-aged adolescents and young adults in the United States.
Associated Publication
Neilan A, Dunville R, Ocfemia MC, Salomon J, Francke J, Wang LY, Bulteel A, Hsu K, DiNenno E, Parker R, Walensky R. Screening adolescents and young adults for HIV in the United States: A cost-effectiveness analysis. J Adolesc Health. 2017;60(2):S18. doi:10.1016/j.jadohealth.2016.10.055