Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA.
Medical Research Council Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom.
J Acquir Immune Defic Syndr. 2020 Dec 1;85(4):395-398. doi: 10.1097/QAI.0000000000002477.
In the 2019 State of the Union Address, President Trump announced a plan for "Ending the HIV Epidemic" in the United States, with a goal to reduce new HIV infections by 90% by 2030. Phase I of the plan set an intermediate goal of a 75% reduction within 5 years, focusing on select states and counties.
We assessed the feasibility of the first phase of the plan by estimating the fraction of HIV diagnoses that occur within the targeted region, using a statistical model to predict new HIV cases in each county. We suggested new areas that should be added to the current plan, prioritizing by both a "Density Metric" of new HIV cases and a "Gap Metric" quantifying shortcomings in antiretroviral therapy and pre-exposure prophylaxis uptake.
We found the current plan targets less than 60% of new diagnoses. The plan should be expanded to Puerto Rico, Florida, Georgia, Louisiana, and Maryland as well as parts of New York, North Carolina, Texas, and Virginia, areas which were prioritized by both metrics.
Many of the highest priority areas, both by density of HIV cases and by lack of viral suppression and pre-exposure prophylaxis use, were not covered by the original plan, particularly in the South. The current plan to end the HIV epidemic must be expanded to these areas to feasibly allow for a 75% reduction in new HIV cases within 5 years.
在 2019 年国情咨文中，特朗普总统宣布了一项在美国“终结艾滋病疫情”的计划，目标是到 2030 年将新感染艾滋病的人数减少 90%。该计划的第一阶段设定了一个 5 年内减少 75%的中期目标，重点关注选定的州和郡。
我们通过使用统计模型预测每个县的新艾滋病病例，评估了该计划第一阶段的可行性，该模型用于估计目标区域内发生的艾滋病诊断比例。我们建议在当前计划中增加新的区域，优先考虑新艾滋病病例的“密度指标”和量化抗逆转录病毒治疗和暴露前预防药物使用不足的“差距指标”。
我们发现当前的计划目标是不到 60%的新诊断病例。该计划应扩大到波多黎各、佛罗里达、佐治亚、路易斯安那和马里兰州，以及纽约、北卡罗来纳、得克萨斯和弗吉尼亚州的部分地区，这两个指标都对这些地区进行了优先排序。
许多最高优先级的地区，无论是艾滋病病例密度还是病毒抑制和暴露前预防药物使用不足，都没有被原始计划涵盖，特别是在南部。要想在 5 年内切实减少 75%的新艾滋病病例，目前终结艾滋病疫情的计划必须扩大到这些地区。
