BACKGROUND: Elimination of racial/ethnic (r/e) disparities is a goal of the Ending the HIV Epidemic in the U.S. (EHE) initiative. Despite progress in HIV prevention and treatment, large r/e disparities in HIV incidence remain. We used the HIV Optimization and Prevention Economics (HOPE) model to analyze which interventions provide the most effective path towards eliminating r/e disparities in HIV incidence.
METHODS: We considered a baseline Scenario A, which assumed continuation of HIV continuum of care and prevention efforts (pre-exposure prophylaxis (PrEP) and syringe services programs (SSPs) at 2022 levels from 2023-2035. We considered three r/e groups: Black, Hispanic/Latino (H/L), and the remaining mostly White population grouped as Other. The primary outcome is the incidence-rate-ratio (IRR) compared to Other, with the goal of IRR1 for both Black and H/L by 2035. We considered four intervention scenarios, B through E, by adjusting input values from 2023-2027, then we observed outcomes from 2027-2035: • Scenario B: Continuum-only - HIV testing, linkage to care and viral suppression among Black and H/L brought to parity with Other by 2027 • Scenario C: Prevention-only – PrEP and SSP uptake among Black and H/L brought to parity with Other by 2027 • Scenario D: Continuum+Prevent- Combined B and C • Scenario E: Max reach- Black and H/L populations reach 98% awareness, linkage to care, and viral suppression coupled with increases in PrEP and SSP uptake by 2027
RESULTS: Scenario B was more effective in reducing incidence in 2035 (9.1 new infections per 100,000) than Scenario C (12.1) compared with baseline Scenario A (13.3). The combined Scenario D resulted in only slight improvements (8.4 new infections per 100,000) compared to Scenario B. All scenarios reduced IRRs, but only Scenario E eliminated incidence disparities by 2035, with respective IRRs of 0.9 and 1.1 among the H/L and Black populations.
CONCLUSIONS: With no changes, disparities in IRR will persist through 2035. Eliminating r/e disparities in the continuum-of-care by 2027 can reduce, but not eliminate, incidence disparities by 2035. Prevention-based interventions are less effective than continuum-based interventions in reducing both overall incidence and r/e incidence disparities; and provide only small added benefit when supplementing continuum-of-care intervention parity. Elimination of r/e incidence disparities by 2035 is only possible if Black and H/L populations reach highest possible care and prevention levels by 2027.
