Timely HIV diagnosis and treatment are critical to preventing transmission. To help make this happen, the U.S. Centers for Disease Control and Prevention (CDC) provides funding for HIV testing to local health departments and community organizations. In a new NIH-funded Johns Hopkins Medicine study, researchers used a computer model to quantify the effect of funding cuts for HIV testing. They estimate that HIV infections could increase an average of 10% in 18 U.S. states if this funding is interrupted or ended.
"The HIV epidemic has been going on for 40 years," says study lead researcher Todd T. Fojo, M.D., M.H.S., associate professor of medicine at the Johns Hopkins University School of Medicine. "The United States has made tremendous progress over the years, with fewer people getting infected and better treatments for those who are infected. To enter a world where that suddenly reverses would be a big deal. Treating someone with HIV over a lifetime is expensive, so any HIV infection you can prevent saves a lot of money."
The study was published February 4 in the journal Clinical Infectious Diseases.
"Once you are diagnosed with HIV, you get treated, and in turn, you can't transmit it," Fojo says. "If more people are unaware they have HIV because effective testing isn't available, it is more likely that they will transmit the virus to someone else."
The simulation model examined HIV infections across 18 states, with populations representing different groups of age, race and sex. The model estimates how frequently populations are being tested and how many of those tests are being done using CDC funding.
"Looking across the 18 states in total, you would have 12,751 more infections over the next five years," Fojo says. "That's 10% more infections than you would have if CDC-funded tests continue at their current pace."
Fojo says that the number varies widely across states.
"The biggest driver is how much testing is already going on in the state and how much testing is done through CDC funding," Fojo explained. "For example, in Washington state, our model predicts that the number of infections increases by 2.7% without CDC-funded tests, but in Louisiana, infections would increase by almost 30%. We know that CDC-funded tests are diagnosing more infections in Louisiana than in Washington state, so the model's prediction makes sense."
"In general," he adds, "If you look at states that have more of a rural HIV epidemic, those states tend to be more impacted when you take away funding for HIV testing."
Fojo says the next steps in this research are to get a more comprehensive idea of what loss of CDC funding for other prevention activities may look like, and what would be the effect of those cuts on HIV infections in the United States.
Other Johns Hopkins Medicine researchers include Melissa Schnure, Ph.D., Sc.M., Kelly A. Gebo, M.D., M.P.H., and Maunank Shah, M.D., Ph.D. Researchers from the Johns Hopkins Bloomberg School of Public Health include Ryan Forster, Ph.D., Keri N. Althoff, Ph.D., M.P.H., David W. Dowdy, M.D., Ph.D., and Parastu Kasaie, Ph.D., M.S. Ruchita Balasubramanian, M.Phil, and William P. Hanage, Ph.D., of the Harvard T.H. Chan School of Public Health also contributed to this research, as did D. Scott Batey, Ph.D., M.S.W., of the Tulane School of Social Work.
All authors have no conflicts of interest to declare.
