Allocating Resources to Reduce HIV in the US: New Paper Outlines Optimal Approach

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In 2019, the US Department of Health and Human Services (HHS) announced the “Ending the HIV Epidemic: A Plan for America” initiative. As part of that initiative, CDC, RTI Health Solutions (RTI-HS), and RTI International researchers performed a study on allocating funds for HIV prevention to maximize reduction of new infections. Previous studies have limited their reach to assessing funding from one or two federal agencies. This evaluation encompassed both public and private funding to estimate the societal allocation of resources.

Researchers used a national model to simulate the number of persons involved in sexual activity and drug use in the US and resulting new HIV infections over a 10-year period. They estimated current spending on four types of prevention programs: HIV screening, interventions that move persons diagnosed with HIV along the care continuum, pre-exposure prophylaxis, and syringe exchange programs. They then compared the current funding allocation against two scenarios in which allocations were identified to minimize new HIV infections. One scenario assumed that only a certain amount of eligible people could be reached with interventions (“limited reach” scenario) and the other assumed that all eligible people could be reached (“unlimited reach” scenario).

The model demonstrated that compared to current funding allocations, optimal funding of HIV prevention funds in the limited reach scenario could reduce the number of new infections by almost 70% and the unlimited reach scenario would provide over a 90% reduction in incidence over the next ten years. The optimized funding allocations resulted in prompt diagnosis and sustained viral suppression through improved screening of high-risk persons and treatment-adherence support for those infected.

“We’re excited to contribute this important research that can help guide decisions about our country’s investments in fighting HIV,” said study co-author Katherine Hicks, Senior Director of Health Economics at RTI Health Solutions. “Understanding where to focus efforts and funding is a vital component in conquering this epidemic.”

Sansom SL, Hicks KA, Carrico J, et al. Optimal allocation of societal HIV prevention resources to reduce HIV incidence in the United States. Am J Public Health. 2021;111(1):150–158. DOI: https://doi.org/10.2105/AJPH.2020.305965

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