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Amanda Bleichrodt, MPH, discusses her team’s findings that the US is unlikely to reach the Ending the HIV Epidemic goal of a 90% drop in HIV incidence by 2030.

Targeted action is needed in the US, to reach a 90% reduction in HIV incidence by 2030 for the Ending the HIV Epidemic goal, according to findings published in AIDS.

“Although the forecasted national-level decrease in the number of incident HIV diagnoses is encouraging, the US is unlikely to achieve the Ending the HIV Epidemic in the US goal of a 90% reduction in HIV incidence by 2030,” Amanda M. Bleichrodt, MPH, and colleagues wrote.

“The observed increases among specific subpopulations highlight the importance of a targeted and equitable approach to effectively combat HIV in the US,” they added.

CDC Data

Bleichrodt and colleagues used publicly available surveillance data on HIV and indicators on social determinants of health from CDC to predict the HIV burden in the US nationally and by region, transmission type, and race or ethnicity through 2030.

The researchers generated 11-year prospective forecasts of incident HIV diagnoses nationally and by region (South, non-South), race or ethnicity (White, Hispanic/Latino, Black/African American), and transmission type (Injection Drug Use, Male-to-Male Sexual Contact [MMSC], and Heterosexual Contact [HSC]).

Using weighted (W) and unweighted (UW) n-sub-epidemic ensemble models, calibrated on 2008-2019 historical data, they forecasted 2020-2030 trends and compared results to identify persistent, concerning trends across models.

Their analysis projected, from 2019 to 2030, the following:

— Large decreases in incident HIV diagnoses in the following areas

• Nationally: W, 27.9%; UW, 21.9%
• The South: W,18.0%; UW, 9.2%
• The non-South: W, 21.2%; UW, 19.5%

— Non-decreasing trends nationally in key subpopulations

• Hispanic/Latino people: W, 1.4%; UW, 2.6%
• Hispanic/Latino MMSC: W, 9.0%; UW, 9.9%
• People who inject drugs: W, 25.6%; UW, 9.2%
• White people who inject drugs: W, 3.5%; UW, 44.9%

— Rising trends among Hispanic/Latino MMSC and overall, among people who inject drugs, consistent across the South and non-South regions

Bleichrodt spoke with Physician’s Weekly (PW) about this research and the urgent need for action to reduce HIV transmission in the US.

PW: Why was it important to do this study?

Bleichrodt: Real-time HIV forecasting efforts can provide critical insights into the effectiveness of existing interventions and policies. However, forecasting efforts that focus on the overall picture or narrow scope of communities, geographies, and transmission types can cause important trends to be overlooked.

Ensuring continued progress toward the EHE goal requires comprehensive, updated, real-time forecasts of the HIV burden in the United States. These analyses allow us to identify potential emerging trends and needed strategy shifts or resource allocation changes.

Did the results surprise you?

Our results were not entirely surprising given the well-established heterogeneous burden of HIV in the United States, results from previous HIV-modeling studies, as well as persistent racial, ethnic, and geographical inequities along the HIV care continuum in the United States.

Are any strengths or limitations especially noteworthy?

Any forecasting analysis comes with inherent uncertainty, which our study is not immune to. However, our study addresses that uncertainty by using the ensemble n-sub-epidemic framework that has shown previous success in the context of forecasting COVID-19 and mpox. We provide a table that allows readers to better assess data sparsity and interpret model divergences, as well as extensive discussion on the uncertainties between models and guidance on how to interpret results.

How could the findings affect treatment and policies for people with HIV?

While we projected an overall decrease in the number of HIV diagnoses through 2030, as have previous studies, our results underscore the importance of not taking a one-size-fits-all approach to reducing HIV incidence in the US. Specifically, the persistent non-decreasing trends forecasted for some communities further support the need for local, state, and national governments to prioritize HIV care for populations who are considerably impacted by HIV.

What further research are you planning?

Given the potential concerning trends projected for already heavily burdened communities, what changes, and what magnitude of change, are needed that can be quickly made at the local, state, and federal levels to move toward reduced transmission? I plan to further investigate this, along with how persistent inequities in access to HIV care for marginalized communities continue to drive unfavorable health outcomes.

What additional comments would you like to share with clinicians?

Now is not the time for complacency. With the EHE goal deadline approaching, addressing the heterogeneous burden of HIV in the United States is critical for achieving a significant reduction in transmission.

To reach the 90% reduction target by 2030, we need to advocate for and prioritize increased access to HIV care for disproportionately impacted populations. We also need to tailor interventions and policies to the diverse landscape of the HIV epidemic.