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Summary of Annals of Internal Medicine. ANNALS-25-01737. https://doi.org/10.7326/ANNALS-25-01737
Dr. Ryan Forster et al.
Points
- A simulation study projected the potential impact of ending the Ryan White HIV/AIDS Program on HIV incidence.
- The study used a compartmental HIV transmission model calibrated to surveillance data from 31 U.S. cities.
- Cessation of services in July 2025 could result in over 75,000 additional infections through 2030.
- This represents a 49% increase in HIV incidence, with varied impacts across different cities.
- Even conservative estimates showed tens of thousands of excess infections, underscoring the program’s importance.
Summary
A recent simulation study investigated the potential impact of disrupting the Ryan White HIV/AIDS Program on HIV incidence across 31 high-burden U.S. cities. Utilizing a compartmental HIV transmission model, calibrated with surveillance data from the U.S. Centers for Disease Control and Prevention and program reports, researchers projected HIV incidence through 2030 under various scenarios. These scenarios included continued services, complete cessation in July 2025, and interruptions until January 2027 (18 months) or January 2029 (42 months).
The base-case analysis revealed a significant public health risk associated with ending Ryan White services. A complete cessation in July 2025 was projected to lead to an estimated 75,436 additional HIV infections (95% credible interval [CrI], 19,251 to 134,175 infections) through 2030. This represents a 49% (95% CrI, 12% to 86%) increase in incidence, with city-specific increases ranging from 9% in Riverside, California, to 110% in Baltimore, Maryland. Shorter interruptions also demonstrated substantial increases, with 18-month and 42-month interruptions yielding 19% and 38% more infections, respectively.
Sensitivity analysis, employing a more conservative estimate for loss of viral suppression, still projected a substantial 34,051 excess infections (95% CrI, 23,902 to 45,147 infections). These findings underscore the critical role of the Ryan White HIV/AIDS Program in preventing HIV transmission. The study highlights the program’s significant public health value and the potential for a sharp increase in HIV incidence if its services are disrupted.
Link to the article: https://www.acpjournals.org/doi/10.7326/ANNALS-25-01737
References
Forster, R., Schnure, M., Jones, J., Lesko, C., Batey, D. S., Butler, I., Ward, D., Musgrove, K., Althoff, K. N., Jain, M. K., Gebo, K. A., Dowdy, D. W., Shah, M., Kasaie, P., & Fojo, A. T. (2025). The potential impact of ending the ryan white hiv/aids program on hiv incidence: A simulation study in 31 u. S. Cities. Annals of Internal Medicine, ANNALS-25-01737. https://doi.org/10.7326/ANNALS-25-01737
