Prevention and treatment produced large decreases in HIV incidence in a model of people who inject drugs

Health Aff (Millwood). 2014 Mar;33(3):401-9. doi: 10.1377/hlthaff.2013.0824.


In the United States, people who inject drugs continue to be at greatly increased risk of HIV infection. To estimate the effectiveness of various prevention scenarios, we modeled HIV transmission in a dynamic network of drug users and people who did not use drugs that was based on the New York Metropolitan Statistical Area population. We compared the projected HIV incidence in 2020 and 2040 if current approaches continue to be used to the incidence if one or more of the following hypothetical interventions were applied: increased HIV testing, improved access to substance abuse treatment, increased use of needle and syringe programs, scaled-up treatment as prevention, and a "high impact" combination scenario, consisting of all of the strategies listed above. No strategy completely eliminated HIV transmission. The high-impact combination strategy produced the largest decrease in HIV incidence-a 62 percent reduction compared to the status quo. Our results suggest that increased resources for and investments in multiple HIV prevention approaches will be required to eliminate HIV transmission among people who inject drugs.

Keywords: AIDS/HIV; Epidemiology; Mental Health/Substance Abuse; Public Health; Special Populations.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Computer Simulation
  • Female
  • Forecasting
  • HIV Infections / drug therapy
  • HIV Infections / epidemiology*
  • HIV Infections / prevention & control*
  • HIV Infections / transmission
  • Health Services Accessibility / statistics & numerical data
  • Humans
  • Incidence
  • Male
  • New York City
  • Stochastic Processes
  • Substance Abuse Treatment Centers / statistics & numerical data
  • Substance Abuse, Intravenous / complications*
  • Substance Abuse, Intravenous / epidemiology*
  • Treatment Outcome
  • Utilization Review / statistics & numerical data