Cover: Test-and-treat in Los Angeles

Test-and-treat in Los Angeles

A Mathematical Model of the Effects of Test-And-Treat for the Population of Men Who Have Sex with Men in Los Angeles County

Published in: Clinical Infectious Diseases, v. 56, no. 12, June 2013, p. 1789-1796

by Neeraj Sood, Zachary Wagner, Amber Jaycocks, Emmanuel Fulgence Drabo, Raffaele Vardavas

View related products

Read More

Access further information on this document at Clinical Infectious Diseases

This article was published outside of RAND. The full text of the article can be found at the link above.

Abstract

BACKGROUND: There is evidence to suggest that antiretroviral therapy (ART) and testing for human immunodeficiency virus (HIV) reduce the probability of transmission of HIV. This has led health officials across the United States to take steps toward a test-and-treat policy. However, the extent of the benefits generated by test-and-treat is debatable, and there are concerns, such as increased multidrug resistance (MDR), that remain unaddressed. METHODS: We developed a deterministic epidemiologic model to simulate the HIV/AIDS epidemic for men who have sex with men (MSM) in Los Angeles County (LAC). We calibrated the model to match the HIV surveillance data from LAC across a 10-year period, starting in 2000. We then modified our model to simulate the test-and-treat policy and compared epidemiologic outcomes under the test-and-treat scenario to the status quo scenario over the years 2012–2023. Outcome measures included new infections, deaths, new AIDS cases, and MDR. RESULTS: Relative to the status quo, the test-and-treat model resulted in a 34% reduction in new infections, 19% reduction in deaths, and 39% reduction in new AIDS cases by 2023. However, these results are counterbalanced by a near doubling of the prevalence of MDR (9.06% compared to 4.79%) in 2023. We also found that the effects of increasing testing and treatment were not complementary. CONCLUSIONS: Although test-and-treat generates substantial benefits, it will not eliminate the epidemic for MSM in LAC. Moreover, these benefits are counterbalanced by large increases in MDR.

Related Products

Research conducted by

This report is part of the RAND Corporation external publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.