People who inject drugs continue to be at greatly increased risk of HIV infection in the United States. We modeled HIV transmission in a dynamic network of drug users and non-drug users (representing the New York metropolitan statistical area population) to estimate the effectiveness of various combination prevention scenarios. We first assumed that current approaches continue (status quo), and then compared projected HIV incidence at 2020 and 2040 to those derived from hypothetical initiatives: (1) scale-up HIV testing, (2) increased access to substance abuse treatment, (3) improved coverage of needle and syringe programs, (4) scaling up Treatment as Prevention; and (5), “high-impact“ combination prevention, combining strategies (1) through (4). No strategy completely eliminated HIV transmission. High-impact prevention produced the largest decrease in HIV incidence, a 62% reduction compared to the status quo. Increased resources for and investment in multi-modality HIV prevention approaches will be required to eliminate HIV transmission among people who inject drugs.
Below: Projected HIV incidence (per 1,000 person-years) at 2040 among PWID residing in the New York metropolitan area, for hypothetical HIV prevention strategies
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