The HIV Epidemic in the United States - Epidemiological Projections and Public Economic Impact of Achieving Zero Transmission Goals.

Background: The United States (US) HIV/AIDS strategy has targeted a 90% reduction in HIV infections by 2030. Whilst progress has been made in US HIV policy, the persistence of nearly 32,000 new infections annually highlights substantial barriers that still hinder effective treatment and the achievement of national targets. While the humanistic burden of HIV is well documented, there are broader economic effects on employment, disability and retirement. The objective of this study is to evaluate these economic gains when improving various HIV policies. Methodology: This analysis adapts a published Markov model assessing the role of six key policy parameters related to diagnosis, pre-exposure prophylaxis (PrEP) uptake, treatment initiation, and treatment as prevention (TasP) on the HIV epidemic in the US. Improvements in these parameters were explored to estimate averted HIV infections over 50 years and, subsequently, the feasibility of achieving the 2030 target of a 90% reduction in HIV incidence.A fiscal economic framework was also applied, linking HIV cases and policy targets to productivity, tax revenue, transfer benefits, and healthcare costs incurred by the US government. Results: Results were calculated for the general US population and for men who have sex with men (MSM), a subgroup experiencing a high HIV burden. For the general US population, policy improvements led to an average of 5,324 averted HIV infections annually over the 50-year horizon, corresponding to a total net annual fiscal gain of $397 million or $74,511 per averted infection. For the MSM subgroup, 911 infections were averted annually resulting in a net fiscal gain of $96 million, or $105,031 per averted infection. Conclusion: This analysis demonstrates that the benefits of HIV policy are not limited to the healthcare setting and show how initial investments provide long-term benefits by preventing HIV transmission and the associated impact on individuals' labor market outcomes. While relying on assumptions and projections that may not capture all real-word complexities, fiscal analyses can provide a useful tool for policy evaluation that facilitate a holistic assessment of the wider costs and benefits that fall on governments as well as benefits of achieving policy targets.