title: The Impact of Implementing a Test, Treat and Retain HIV Prevention Strategy in Atlanta among Black Men Who Have Sex with Men with a History of Incarceration: A Mathematical Model.
abstract: BACKGROUND
  Annually, 10 million adults transition through prisons or jails in the United States (US) and the prevalence of HIV among entrants is three times higher than that for the country as a whole. We assessed the potential impact of increasing HIV Testing/Treatment/Retention (HIV-TTR) in the community and within the criminal justice system (CJS) facilities, coupled with sexual risk behavior change, focusing on black men-who-have-sex-with-men, 15-54 years, in Atlanta, USA.
  
  
  METHODS
  We modeled the effect of a HIV-TTR strategy on the estimated cumulative number of new (acquired) infections and mortality, and on the HIV prevalence at the end of ten years. We additionally assessed the effect of increasing condom use in all settings.
  
  
  RESULTS
  In the Status Quo scenario, at the end of 10 years, the cumulative number of new infections in the community, jail and prison was, respectively, 9246, 77 and 154 cases; HIV prevalence was 10815, 69 and 152 cases, respectively; and the cumulative number of deaths was 2585, 18 and 34 cases, respectively. By increasing HIV-TTR coverage, the cumulative number of new infections could decrease by 15% in the community, 19% in jail, and 8% in prison; HIV prevalence could decrease by 8%, 9% and 7%, respectively; mortality could decrease by 20%, 39% and 18%, respectively. Based on the model results, we have shown that limited use and access to condoms have contributed to the HIV incidence and prevalence in all settings.
  
  
  CONCLUSIONS
  Aggressive implementation of a CJS-focused HIV-TTR strategy has the potential to interrupt HIV transmission and reduce mortality, with benefit to the community at large. To maximize the impact of these interventions, retention in treatment, including during the period after jail and prison release, and increased condom use was vital for decreasing the burden of the HIV epidemic in all settings.
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada; Department of Medicine, Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Viviane D
authors.initials: VD
authors.lastname: Lima
authors.affiliation: Department of Mathematics, Simon Fraser University, Burnaby, Canada.
authors.forename: Isabell
authors.initials: I
authors.lastname: Graf
authors.affiliation: Alpert Medical School of Brown University, The Miriam Hospital, Providence, Rhode Island, United States of America.
authors.forename: Curt G
authors.initials: CG
authors.lastname: Beckwith
authors.affiliation: Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, Connecticut, United States of America.
authors.forename: Sandra
authors.initials: S
authors.lastname: Springer
authors.affiliation: Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, Connecticut, United States of America; Yale University School of Public Health, Division of Epidemiology of Microbial Diseases, New Haven, Connecticut, United States of America.
authors.forename: Frederick L
authors.initials: FL
authors.lastname: Altice
authors.affiliation: Department of Mathematics, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Daniel
authors.initials: D
authors.lastname: Coombs
authors.forename: Bryan
authors.initials: B
authors.lastname: Kim
authors.affiliation: Rollins School of Public Health Department of Epidemiology, Emory University School of Medicine, Atlanta, United States of America.
authors.forename: Brian
authors.initials: B
authors.lastname: Kim
authors.affiliation: Rollins School of Public Health Department of Epidemiology, Emory University School of Medicine, Atlanta, United States of America.
authors.forename: Lauren
authors.initials: L
authors.lastname: Messina
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada; Department of Medicine, Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Julio S G
authors.initials: JS
authors.lastname: Montaner
authors.affiliation: Rollins School of Public Health Department of Epidemiology, Emory University School of Medicine, Atlanta, United States of America.
authors.forename: Anne
authors.initials: A
authors.lastname: Spaulding
mesh_terms: D015492:AIDS Serodiagnosis; D001741:Black or African American; D005845:Georgia; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000517:prevention & control*; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008962:Models, Theoretical