Localized economic modeling to support implementation of the Ending the HIV Epidemic initiative

Rather than a homogeneous national epidemic, the HIV epidemic in the United States is a collection of local microepidemics concentrated primarily in the South, hotspot counties, and large urban centers, with fundamental differences in health system infrastructure, funding and HIV-related laws and policies across jurisdictions. Recognizing these facts, the US launched the ambitious ‘Ending the HIV Epidemic (EHE) initiative in February 2019. The plan called for an initial focus on 48 counties accounting for more than 50% of all new HIV diagnoses plus Washington, DC, San Juan, Puerto Rico and seven states with substantial rural burden to reduce new infections by 75% within 5 years and by 90% within 10 years. These goals are now challenged by the onset of the global COVID-19 pandemic, which may have severe consequences for people living with HIV and HIV microepidemics across the US. A value-based approach that accounts for the pervasive demographic differences in rates in healthcare access and explicating key elements of the implementation process needed to reach optimal levels of service delivery are now more critical than ever in reaching the ambitious targets of the EHE initiative. In this renewed project, we proposed an integrated set of aims, executed in parallel, with the goal of establishing a decision-making platform that considers all strategies relevant to communities and decision-makers in EHE-targeted jurisdictions, acknowledges COVID-19-related disruptions in access to services, and integrates new evidence as it emerges. We proposed to expand our focal set of evidence-based interventions to Diagnose, Treat and Prevent HIV infection to also consider the potential impact of the Respond pillar of the EHE initiative; to work with local communities and public health officials to refine and tailor our analysis to local needs and constraints; and to extend our geographic focus to cover each of the jurisdictions targeted in phase 1 of the EHE initiative, applying a novel approach, distributional cost-effectiveness analysis, to simultaneously maximize the impact of local HIV responses and reduce demographic differences in differences in rates in healthcare access.