The Potential Impact of Ending the Ryan White HIV/AIDS Program on HIV Incidence: A Simulation Study in 31 U.S. Cities

作者：Ryan Forster, Melissa Schnure, Joyce Jones, Catherine R. Lesko, D. Scott Batey, Isolde Butler, Dafina Ward, Karen Musgrove, Keri N. Althoff, Mamta K. Jain, Kelly A. Gebo, David W. Dowdy, Maunank Shah, Parastu Kasaie, Anthony T. Fojo · 发表于：Annals of Internal Medicine · 年份：2025 · DOI：10.7326/annals-25-01737 · 被引用次数：14 · 研究领域：HIV/AIDS Research and Interventions、HIV Research and Treatment、Adolescent Sexual and Reproductive Health

BACKGROUND: With antiretroviral therapy, people with HIV can live a normal lifespan and not transmit HIV. The Ryan White HIV/AIDS Program provides care for over half of people with HIV in the United States. OBJECTIVE: To estimate how many HIV infections could result from cessation of Ryan White services or interruptions lasting 18 to 42 months. DESIGN: A compartmental HIV transmission model was used to simulate epidemics and Ryan White service use. DATA SOURCES: The researchers calibrated model transmission to surveillance data from the U.S. Centers for Disease Control and Prevention in each city and calibrated the number of Ryan White clients to program reports. Ryan White clinic directors and administrators were surveyed to estimate how many clients would lose viral suppression if services stopped. TARGET POPULATION: Simulated HIV epidemics in 31 high-burden U.S. cities. TIME HORIZON: Through 2030. PERSPECTIVE: Not applicable. INTERVENTION: The researchers projected HIV incidence under the following 4 scenarios: continued services, cessation in July 2025, interruption until January 2027, and interruption until January 2029. OUTCOME MEASURES: Projected excess HIV infections from 2025 to 2030. RESULTS OF BASE-CASE ANALYSIS: Ending Ryan White services in July 2025 could result in 75 436 additional infections (95% credible interval [CrI], 19 251 to 134 175 infections) through 2030-a 49% (95% CrI, 12% to 86%) increase. Increases ranged from 9% (Riverside, California) to 110% (Ba...