Jacobson EU, Hicks KA, Carrico J, Purcell DW, Green TA, Mermin JH, Farnham PG. Optimizing HIV prevention efforts to achieve EHE incidence targets. J Acquir Immune Defic Syndr. 2021 Dec 14. doi: 10.1097/QAI.0000000000002885.

BACKGROUND: A goal of the US Department of Health and Human Services’ Ending the HIV Epidemic in the U.S. (EHE) initiative is to reduce annual numbers of incident HIV infections in the United States by 75% within 5 years, and by 90% within 10 years. We developed a resource allocation analysis to understand how these goals might be met.

METHODS: We estimated current annual societal funding ($2.8B/year) for 14 interventions to prevent HIV and facilitate treatment of infected persons. These interventions included HIV testing for different transmission groups, HIV care-continuum interventions, pre-exposure prophylaxis (PrEP), and syringe services programs (SSP). We developed scenarios optimizing or reallocating this funding to minimize new infections, and we analyzed the impact of additional EHE funding over the period 2021 to 2030.

RESULTS: With constant current annual societal funding of $2.8B/year for 10 years starting in 2021, we estimated annual incidence in 2030 of 36,000 new cases. When we added annual EHE funding of $500M/year for 2021-2022, $1.5B/year for 2023-2025, and $2.5B/year for 2026-2030, annual incidence in 2030 decreased to 7,600 cases (no optimization), 2,900 cases (optimization beginning in 2026), and 2,200 cases (optimization beginning in 2023).

CONCLUSIONS: Even without optimization, significant increases in resources could lead to an 80% decrease in annual HIV incidence in 10 years. However, to reach both EHE targets, optimization of prevention funding early in the EHE period is necessary. Implementing these efficient allocations would require flexibility of funding across agencies, which might be difficult to achieve.

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