Modeling HIV transmission implications of the United States' HIV Care Continuum

Eli Rosenberg, Ph.D.
Emory University

ABSTRACT:
Over 1.2 million individuals in the United States are estimated to be living with HIV infection, with about 45,000 new infections occurring annually. Although HIV prevention has classically been conceptualized in terms of preventing HIV-negative individuals from acquiring HIV, recent studies of antiretroviral therapy (ART) for those living with HIV have demonstrated that achieving viral suppression drastically reduces the likelihood of onward transmission. Thus, while ART has long been used to clinically control HIV infection, there is a new understanding that widespread usage of effective ART can have important implications for HIV prevention. The HIV care continuum has become an important framework for understanding the extent to which a population of individuals living with HIV infection are receiving effective care, through stages of diagnosis, HIV care engagement, antiretroviral therapy prescription, and achieving viral suppression. Unfortunately, a number of barriers exist in the US that yield low levels of viral suppression among those living with HIV. In this presentation, I will discuss two recently published modeling analyses that translate data on the US care continuum into information about HIV transmissions from those living with HIV. These models indicate the burden of transmissions attributable to sub-groups in terms of care stage, and key demographic groups, as well as the potential long-term impact of care-achievement targets of the US National HIV/AIDS Strategy.