Ending the HIV Epidemic in the United States Among Men Who Have Sex With Men: A Modeling Analysis

The Ending the HIV Epidemic in the US (EHE) initiative, launched by the White House in 2019, aims to reduce HIV transmissions by 75% by 2025 and 90% by 2030 as compared with total annual transmissions in 2017. We sought to determine levels of improvement in testing, care, and prevention needed to meet the EHE goals for men who have sex with men (MSM) in the United States.

We modeled HIV transmissions based on current care (Status quo) and strategies improving HIV testing, treatment, and/or preexposure prophylaxis (PrEP). Status quo included testing frequency (every 6.8 years), antiretroviral therapy linkage (77%), care engagement (78%), viral suppression (81%), and PrEP coverage (41% for MSM at increased HIV infection risk, 7% for lower risk). The primary outcome was percentage reduction in HIV transmissions. We examined data uncertainty in sensitivity analysis.

Status quo would reduce HIV transmissions by 32% by 2035. The most influential individual intervention would be improved engagement in HIV care (67% reduction in transmissions with 98% engagement). Combined testing and care interventions at high levels, with expanded PrEP for MSM at increased risk, could achieve 89% reduction by 2035.

Only with major improvements in HIV testing, care, and prevention will EHE goals be met by 2036.