TY - JOUR
T1 - Test-and-treat in los angeles
T2 - A mathematical model of the effects of test-and-treat for the population of men who have sex with men in Los Angeles County
AU - Sood, Neeraj
AU - Wagner, Zachary
AU - Jaycocks, Amber
AU - Drabo, Emmanuel
AU - Vardavas, Raffaele
N1 - Funding Information:
Financial support. This work was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (grant number R01HD054877). The funding source had no role in the design or conduct of this study.
PY - 2013/6/15
Y1 - 2013/6/15
N2 - Background. There is evidence to suggest that antiretroviral therapy (ART) and testing for human immunodeficiency virus (HIV) reduce the probability of transmission of HIV. This has led health officials across the United States to take steps toward a test-and-treat policy. However, the extent of the benefits generated by test-and-treat is debatable, and there are concerns, such as increased multidrug resistance (MDR), that remain unaddressed.Methods. We developed a deterministic epidemiologic model to simulate the HIV/AIDS epidemic for men who have sex with men (MSM) in Los Angeles County (LAC). We calibrated the model to match the HIV surveillance data from LAC across a 10-year period, starting in 2000. We then modified our model to simulate the test-and-treat policy and compared epidemiologic outcomes under the test-and-treat scenario to the status quo scenario over the years 2012-2023. Outcome measures included new infections, deaths, new AIDS cases, and MDR.Results. Relative to the status quo, the test-and-treat model resulted in a 34% reduction in new infections, 19% reduction in deaths, and 39% reduction in new AIDS cases by 2023. However, these results are counterbalanced by a near doubling of the prevalence of MDR (9.06% compared to 4.79%) in 2023. We also found that the effects of increasing testing and treatment were not complementary.Conclusions. Although test-and-treat generates substantial benefits, it will not eliminate the epidemic for MSM in LAC. Moreover, these benefits are counterbalanced by large increases in MDR.
AB - Background. There is evidence to suggest that antiretroviral therapy (ART) and testing for human immunodeficiency virus (HIV) reduce the probability of transmission of HIV. This has led health officials across the United States to take steps toward a test-and-treat policy. However, the extent of the benefits generated by test-and-treat is debatable, and there are concerns, such as increased multidrug resistance (MDR), that remain unaddressed.Methods. We developed a deterministic epidemiologic model to simulate the HIV/AIDS epidemic for men who have sex with men (MSM) in Los Angeles County (LAC). We calibrated the model to match the HIV surveillance data from LAC across a 10-year period, starting in 2000. We then modified our model to simulate the test-and-treat policy and compared epidemiologic outcomes under the test-and-treat scenario to the status quo scenario over the years 2012-2023. Outcome measures included new infections, deaths, new AIDS cases, and MDR.Results. Relative to the status quo, the test-and-treat model resulted in a 34% reduction in new infections, 19% reduction in deaths, and 39% reduction in new AIDS cases by 2023. However, these results are counterbalanced by a near doubling of the prevalence of MDR (9.06% compared to 4.79%) in 2023. We also found that the effects of increasing testing and treatment were not complementary.Conclusions. Although test-and-treat generates substantial benefits, it will not eliminate the epidemic for MSM in LAC. Moreover, these benefits are counterbalanced by large increases in MDR.
KW - HIV/AIDS
KW - antiretroviral therapy
KW - drug resistance
KW - mathematical model
KW - test and treat
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U2 - 10.1093/cid/cit158
DO - 10.1093/cid/cit158
M3 - Article
C2 - 23487387
AN - SCOPUS:84878337526
SN - 1058-4838
VL - 56
SP - 1789
EP - 1796
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 12
ER -