To estimate outcomes linked to treatment as prevention (TasP) and their association with HIV incidence and prevalence in the US, while projecting the consequences of potential policy rollbacks on ART access using counterfactual modeling.
Approach:
Model Development: A deterministic analytical model was developed to evaluate TasP outcomes using a dynamic, US-representative cohort of PLHIV categorized into four transmission groups.
Counterfactual Scenarios: Counterfactual modeling was used to assess the impact of maintaining or reducing ART access on HIV incidence and prevalence from 2011 to 2025.
Key Findings:
TasP has been effective in controlling HIV transmission, with no sexual transmission observed when viral suppression is achieved, according to previous studies.
Reductions in AIDS drug assistance programs (ADAP) could lead to thousands of new HIV acquisitions, as indicated by modeling projections.
Modeling indicates that diminished access to ART will likely reverse the progress made in controlling the HIV epidemic, based on historical data.
Interpretation:
The study emphasizes the importance of ART in preventing HIV transmission and highlights potential negative impacts of reduced access to these therapies.
Limitations:
The model does not account for crossover transmission between different groups, which may affect transmission dynamics.
Assumptions regarding the effectiveness of ART and PrEP may not capture all real-world complexities, potentially limiting the model's applicability.
Conclusion:
Access to ART is crucial for maintaining the downward trend in HIV incidence observed since 2011, as indicated by the study's findings.
