Applying Public Health Principles to the HIV Epidemic—How Are We Doing?

January 2016 - Reports, Guidelines, and Tools

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Frieden, T.R., Foti, K.E., and Mermin, J. The New England Journal of Medicine (December 2015), 373:2281-2287, doi: 10.1056/NEJMms1513641.

The authors of this editorial stated that over the past decade, U.S. health departments, community organizations, and health care providers have expanded HIV screening and targeted testing. As a result, a greater proportion of HIV-positive people are now aware of their infection, new diagnoses of HIV infection have decreased, and HIV-positive people are living longer. However, an estimated 45,000 new HIV infections still occur each year in the United States—about 30,000 transmitted by those with diagnosed infection who are not receiving care, and about 10,000 by people with undiagnosed infection. Some communities across the country have implemented successful programs to reduce new infections. For example, a program in San Francisco achieved increased virologic suppression through increased rates of testing (including for recent and acute infection), partner notification, linkage, or re-engagement in care, and treatment of all HIV-positive people. These initiatives, plus access to pre-exposure prophylaxis (PrEP), were associated with a 40 percent decrease in reported new infections between 2006 and 2014. The authors concluded that it is possible to improve early diagnosis by implementing intensive testing, improving partner notification, and testing people in the social networks of HIV-positive individuals. Moreover, targeted PrEP among groups at highest risk can further reduce the number of new infections.

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