Andrew Anglemyer1,2, Noah Haber3,4, Adi Noiman5,6, George Rutherford7, Anuradha Ganesan5,8, Jason Blaylock8, Jason Okulicz9, Ryan C Maves10, Tahaniyat Lalani5,11, Christina Schofield12, James Mancuso13, Brian K Agan5,6. 1. Department of Operations Research, Naval Postgraduate School, 1 University Circle, Monterey, CA 93943, USA. 2. Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand. 3. Carolina Population Center, University of North Carolina, 123 W Franklin St, Chapel Hill, NC 27516, USA. 4. Meta-Research Innovation Center at Stanford University, Stanford, California. 5. Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20852, USA. 6. The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Dr, Bethesda, MD 20817, USA. 7. Prevention and Public Health Group, Epidemiology and Biostatistics, University of California San Francisco, 550 16th Street, Second Floor, San Francisco, CA 94158, USA. 8. Division of Infectious Diseases, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20889, USA. 9. Infectious Disease Service, Brooke Army Medical Center, 3551 Roger Brooke Dr. Fort Sam Houston, TX 78234, USA. 10. Division of Infectious Diseases, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego CA, 92134, TX 78234, USA. 11. Division of Infectious Diseases, Naval Medical Center Portsmouth, 620 John Paul Jones Cir, Portsmouth, VA 23708, TX 78234, USA. 12. Division of Infectious Diseases, Madigan Army Medical Center, 9040A, Jackson Ave, Joint Base Lewis-McChord, WA 98431, TX 78234, USA. 13. Armed Forces Health Surveillance Branch, 7700 Arlington Boulevard, Suite 5101, Falls Church, VA 22042, USA.
Abstract
INTRODUCTION: The new initiative by the Department of Health and Human Services (DHHS) aims to decrease new HIV infections in the U.S. by 75% within 5 years and 90% within 10 years. Our objective was to evaluate whether the U.S. military provides a good example of the benefits of such policies. MATERIALS AND METHODS: We conducted an analysis of a cohort of 1,405 active duty military personnel with HIV enrolled in the Natural History Study who were diagnosed between 2003 and 2015 at six U.S. military medical centers. The study was approved by institutional review boards at the Uniformed Services University of the Health Sciences and each of the sites. We evaluated the impact of Department of Defense (DoD) HIV care policies, including screening, linkage to care, treatment eligibility, and combined antiretroviral therapy (cART) initiation on achieving viral suppression (VS) within 3 years of diagnosis. As a secondary outcome, we evaluated the DoD's achievement of UNAIDS 90-90-90 targets. RESULTS: Nearly all (99%) were linked to care within 60 days. Among patients diagnosed in 2003-2009, 77.5% (95% confidence intervals (CI) 73.9-80.6%) became eligible for cART within 3 years of diagnosis, 70.6% (95% CI 66.6-74.1%) overall initiated cART, and 64.2% (95% CI 60.1-68.0%) overall achieved VS. Among patients diagnosed in 2010-2015, 98.7% (95% CI 96.7-99.5%) became eligible for cART within 3 years of diagnosis, 98.5% (95% CI 96.4-99.4%) overall initiated cART, and 89.8% (95% CI 86.0-92.5%) overall achieved VS. CONCLUSIONS: U.S. military HIV policies have been highly successful in achieving VS goals, exceeding the UNAIDS 90-90-90 targets. In spite of limitations, including generalizability, this example demonstrates the feasibility of the DHHS initiative to decrease new infections through testing, early treatment, and retention in care. Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2020. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
INTRODUCTION: The new initiative by the Department of Health and Human Services (DHHS) aims to decrease new HIV infections in the U.S. by 75% within 5 years and 90% within 10 years. Our objective was to evaluate whether the U.S. military provides a good example of the benefits of such policies. MATERIALS AND METHODS: We conducted an analysis of a cohort of 1,405 active duty military personnel with HIV enrolled in the Natural History Study who were diagnosed between 2003 and 2015 at six U.S. military medical centers. The study was approved by institutional review boards at the Uniformed Services University of the Health Sciences and each of the sites. We evaluated the impact of Department of Defense (DoD) HIV care policies, including screening, linkage to care, treatment eligibility, and combined antiretroviral therapy (cART) initiation on achieving viral suppression (VS) within 3 years of diagnosis. As a secondary outcome, we evaluated the DoD's achievement of UNAIDS 90-90-90 targets. RESULTS: Nearly all (99%) were linked to care within 60 days. Among patients diagnosed in 2003-2009, 77.5% (95% confidence intervals (CI) 73.9-80.6%) became eligible for cART within 3 years of diagnosis, 70.6% (95% CI 66.6-74.1%) overall initiated cART, and 64.2% (95% CI 60.1-68.0%) overall achieved VS. Among patients diagnosed in 2010-2015, 98.7% (95% CI 96.7-99.5%) became eligible for cART within 3 years of diagnosis, 98.5% (95% CI 96.4-99.4%) overall initiated cART, and 89.8% (95% CI 86.0-92.5%) overall achieved VS. CONCLUSIONS: U.S. military HIV policies have been highly successful in achieving VS goals, exceeding the UNAIDS 90-90-90 targets. In spite of limitations, including generalizability, this example demonstrates the feasibility of the DHHS initiative to decrease new infections through testing, early treatment, and retention in care. Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2020. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
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