PURPOSE: First released by President Obama in 2010, the National HIV/AIDS Strategy (NHAS) identifies a set of priorities to prevent and treat HIV in the United States. One NHAS goal is to reduce HIV-related health disparities. HIV surveillance data show that the rate of HIV diagnosis per 100,000 people in 2014 was 49.4 for blacks, 18.4 for Hispanic/Latinos and 6.1 for whites. Another goal is to increase the viral load suppression (VLS) among persons with diagnosed HIV to 80%. We used a mathematical model to understand the effect of achieving the VLS goal on HIV incidence by race/ethnicity.
METHOD: We developed a dynamic, compartmental model of HIV transmission that includes 27 compartments defined by disease status and HIV care continuum stages. The model includes the racial/ethnic groups black, Hispanic/Latino and white/other. We compared the 5-year HIV cumulative incidence from 2016 through 2020 under the baseline assumption of 52% VLS among diagnosed with cumulative incidence over the same period when the 80% VLS goal was reached. We structured the model so that progress toward reaching the VLS goal began in 2016 and the goal was achieved in all racial-ethnic groups by 2020. We reported the reductions in incidence for each group.
RESULT: Over the 5-year period, from 2016 through 2020, HIV incidence dropped by 19% overall, from an estimated 172,362 cases to 140,300 cases when 80% VLS was achieved among all diagnosed with HIV. Incidence reductions by race/ethnicity were 21% for blacks, 25% for Hispanic/Latinos and 14% for white/others.
CONCLUSION: Achieving by 2020 the goal of 80% VLS among people diagnosed with HIV showed the largest benefits for blacks and Hispanics/Latinos, groups that historically have experienced disproportionate HIV incidence. Understanding how people diagnosed with HIV can best achieve and maintain VLS will be important.
