Costs, Consequences and Feasibility of Strategies for Achieving the Goals of the National HIV/AIDS Strategy in the United States: A Closing Window for Success?

Three key policy questions are explored here: Is it still epidemiologically feasible to attain the incidence and transmission
rate reduction goals of the U.S. National HIV/AIDS Strategy (NHAS) by 2015? If so, what costs will be incurred in necessary
program expansion, and will the investment be cost-effective? Would substantial expansion of prevention services for persons
living with HIV (PLWH) augment the other strategies outlined in the NHAS in terms of effectiveness and cost-effectiveness?
Eight policy scenarios were constructed based on three factors (two levels each): expansion (or not) of HIV diagnostic services;
assumptions regarding levels of effectiveness of HIV treatment in achieving suppressed viral load; and possible levels of
expansion of prevention services for PLWH. All scenarios assumed that the NHAS goal of 85 % linkage to HIV care would be fully
achieved by 2015. Standard methods of economic evaluation and epidemiologic modeling were employed. Each of the eight policy
scenarios was compared to a flat transmission rate comparison condition; then, key policy dyads were compared pairwise. Without
expansion of diagnostic services and of prevention services for PLWH, scaling up coverage of HIV care and treatment alone
in the U.S. will not achieve the incidence and transmission rate reduction goals of the NHAS. However, timely expansion of
testing and prevention services for PLWH does allow for the goals to still be achieved by 2015, and does so in a highly cost-effective
manner.