title: Effect of the US National HIV/AIDS Strategy targets for improved HIV care engagement: a modelling study.
abstract: BACKGROUND
  The recently updated White House National HIV/AIDS Strategy (NHAS) includes specific progress indicators to improve the HIV care continuum in the USA, but the economic and epidemiological effect of achieving those indicators remains unclear. We aimed to project the impact of achieving NHAS goals on HIV incidence, prevalence, mortality, and costs among adults in the USA over 10 years.
  
  
  METHODS
  We constructed a dynamic transmission model of HIV progression and care engagement based on literature sources and the most recent published US Centers for Disease Control and Prevention data. We specifically considered achievement of the 2020 targets set forth in NHAS progress indicator 1 (90% awareness of serostatus), indicator 4 (85% linkage within 1 month), and indicator 5 (90% of diagnosed individuals in care).
  
  
  RESULTS
  At current rates of engagement in the HIV care continuum, we project 524,000 (95% uncertainty range 442,000-712,000) new HIV infections and 375,000 deaths (364,000-578,000) between 2016 and 2025. Achievement of NHAS progress indicators 1 and 4 has modest epidemiological effect (new infections reduced by 2·0% and 3·9%, respectively). By contrast, increasing the proportion of diagnosed individuals in care (NHAS indicator 5) averts 52% (95% UR 47-56) of new infections. Achievement of all NHAS targets resulted in a 58% reduction (95% UR 52-61) in new infections and 128 000 lives saved (106,000-223,000) at an incremental health system cost of US$105 billion.
  
  
  CONCLUSIONS
  Achievement of NHAS progress indicators for screening, linkage, and particularly improving retention in care, can substantially reduce the burden of HIV in the USA, but continued and increased financial investment will be required.
  
  
  BACKGROUND
  The National Institutes of Health, the B Frank and Kathleen Polk Assistant Professorship in Epidemiology, Emory University CFAR, Johns Hopkins University CFAR, and CDC/NCHHSTP Epidemiological and Economic Modeling Agreement (5U38PS004646).
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: mshah28@jhmi.edu.
authors.forename: Maunank
authors.initials: M
authors.lastname: Shah
authors.affiliation: Johns Hopkins University, Krieger School of Arts and Sciences, Baltimore, MD, USA.
authors.forename: Allison
authors.initials: A
authors.lastname: Perry
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Risher
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Sunaina
authors.initials: S
authors.lastname: Kapoor
authors.affiliation: Emory University Rollins School of Public Health, Atlanta, GA, USA.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Grey
authors.affiliation: Emory University Rollins School of Public Health, Atlanta, GA, USA.
authors.forename: Akshay
authors.initials: A
authors.lastname: Sharma
authors.affiliation: Emory University Rollins School of Public Health, Atlanta, GA, USA.
authors.forename: Eli S
authors.initials: ES
authors.lastname: Rosenberg
authors.affiliation: Emory University Rollins School of Public Health, Atlanta, GA, USA.
authors.forename: Carlos
authors.initials: C
authors.lastname: Del Rio
authors.affiliation: Emory University Rollins School of Public Health, Atlanta, GA, USA.
authors.forename: Patrick
authors.initials: P
authors.lastname: Sullivan
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: David W
authors.initials: DW
authors.lastname: Dowdy
mesh_terms: D000328:Adult; D003695:Delivery of Health Care; D035082:Federal Government; D005544:Forecasting; D015658:HIV Infections / Q000191:economics / Q000453:epidemiology* / Q000517:prevention & control / Q000628:therapy; D017048:Health Care Costs; D006285:Health Planning; D006291:Health Policy; D006801:Humans; D015994:Incidence; D018803:Models, Economic; D014481:United States / Q000453:epidemiology