title: Test and treat DC: forecasting the impact of a comprehensive HIV strategy in Washington DC.
abstract: BACKGROUND
  The United States and international agencies have signaled their commitment to containing the human immunodeficiency virus (HIV) epidemic via early case identification and linkage to antiretroviral therapy (ART) immediately at diagnosis. We forecast outcomes of this approach if implemented in Washington DC.
  
  
  METHODS
  Using a mathematical model of HIV case detection and treatment, we evaluated combinations of HIV screening and ART initiation strategies. We define current practice as no regular screening program and ART at CD4 counts < or = 350 cells/microL, and we define test and treat as annual screening and administration of ART at diagnosis. Outcomes include life expectancy of HIV-infected persons and changes in the population time with transmissible HIV RNA levels. Data, largely from Washington DC, include undiagnosed HIV prevalence of 0.6%, annual incidence of 0.13%, 31% rate of test offer, 60% rate of acceptance, and 50% linkage to care. Input parameters, including optimized ART efficacy, are varied in sensitivity analyses.
  
  
  RESULTS
  Projected life expectancies, from an initial mean age of 41 years, are 23.9, 25.0, and 25.6 years for current practice, test and treat, and test and treat with optimized ART, respectively. Compared with current practice, test and treat leads to a 14.7% reduction in time spent with transmissible HIV RNA level in the next 5 years; test and treat with optimized ART results in a 27.3% reduction.
  
  
  CONCLUSIONS
  An expanded HIV test and treat program in Washington DC will increase life expectancy of HIV-infected patients but will have a modest impact on HIV transmission over the next 5 years and is unlikely to halt the HIV epidemic.
authors.affiliation: Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts 02114, USA. rwalensky@partners.org
authors.forename: Rochelle P
authors.initials: RP
authors.lastname: Walensky
authors.forename: A David
authors.initials: AD
authors.lastname: Paltiel
authors.forename: Elena
authors.initials: E
authors.lastname: Losina
authors.forename: Bethany L
authors.initials: BL
authors.lastname: Morris
authors.forename: Callie A
authors.initials: CA
authors.lastname: Scott
authors.forename: Erin R
authors.initials: ER
authors.lastname: Rhode
authors.forename: George R
authors.initials: GR
authors.lastname: Seage
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Freedberg
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D003140:Communicable Disease Control / Q000379:methods*; D004219:District of Columbia / Q000453:epidemiology; D005260:Female; D005544:Forecasting; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008962:Models, Theoretical; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents