ARTICLE: The Potential Impact of Ending the Ryan White HIV/AIDS Program on HIV Incidence: A Simulation Study in 31 U.S. Cities
AUTHORS: Ryan Forster, Melissa Schnure, Joyce Jones, Catherine Lesko, D Scott Batey, Isolde Butler, Dafina Ward, Karen Musgrove, Keri N Althoff, Mamta K Jain, Kelly A Gebo, David W Dowdy, Maunank Shah, Parastu Kasaie, Anthony T Fojo
JOURNAL: Ann Intern Med. 2025 Sep 9. doi: 10.7326/ANNALS-25-01737. Online ahead of print.
Abstract
Background: With antiretroviral therapy, people with HIV can live a normal lifespan and not transmit HIV. The Ryan White HIV/AIDS Program provides care for over half of people with HIV in the United States.
Objective: To estimate how many HIV infections could result from cessation of Ryan White services or interruptions lasting 18 to 42 months.
Design: A compartmental HIV transmission model was used to simulate epidemics and Ryan White service use.
Data sources: The researchers calibrated model transmission to surveillance data from the U.S. Centers for Disease Control and Prevention in each city and calibrated the number of Ryan White clients to program reports. Ryan White clinic directors and administrators were surveyed to estimate how many clients would lose viral suppression if services stopped.
Target population: Simulated HIV epidemics in 31 high-burden U.S. cities.
Time horizon: Through 2030.
Perspective: Not applicable.
Intervention: The researchers projected HIV incidence under the following 4 scenarios: continued services, cessation in July 2025, interruption until January 2027, and interruption until January 2029.
Outcome measures: Projected excess HIV infections from 2025 to 2030.
Results of base-case analysis: Ending Ryan White services in July 2025 could result in 75 436 additional infections (95% credible interval [CrI], 19 251 to 134 175 infections) through 2030-a 49% (95% CrI, 12% to 86%) increase. Increases ranged from 9% (Riverside, California) to 110% (Baltimore, Maryland). Interruptions of 18 and 42 months yielded 19% and 38% more infections, respectively.
Results of sensitivity analysis: A "conservative" analysis with lower simulated loss of suppression from observational studies projected 34 051 excess infections (95% CrI, 23 902 to 45 147 infections).
Limitation: The loss of suppression if Ryan White services end may be misestimated by survey responses and observational studies.
Conclusion: Disrupting Ryan White services could sharply increase HIV incidence, highlighting their critical public health value.
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POZ Magazine: If Congress Ends Ryan White HIV Services, How Many Americans Will Contract HIV?
