By Gina Shaw
Tennessee’s decision to reject more than $6 million in CDC funding for HIV prevention, detection and treatment programs, and instead to redirect state resources for HIV prevention to first responders, pregnant individuals and survivors of sex trafficking, will harm high-risk groups while providing only minimal benefit to the new targeted populations, warned Allison Agwu, MD, a professor of pediatric and adult infectious diseases and the head of the pediatric adolescent HIV/AIDS program at the Johns Hopkins University School of Medicine, in Baltimore, during a packed session at IDWeek 2024, in Los Angeles.
In March 2023, Tennessee replaced $6.2 million in CDC HIV prevention funding with state funds, redirecting support away from CDC-prioritized populations, including men who have sex with men (MSM), transgender women and heterosexual Black women, toward the new Tennessee-prioritized populations, who make up only 1% of the people with HIV in Tennessee. The CDC-prioritized populations account for 99% of people with HIV in the state.
In a study published in June 2024, researchers from Massachusetts General Hospital used a microsimulation-based cost-effectiveness model to examine the implications of that reallocation on 10-year HIV transmissions, HIV diagnosis, deaths and life-years saved (Clin Infect Dis 2024 Jun 24). They conducted scenario analyses based on influential variables, with input from Tennessee-based community organizations Nashville CARES and Friends For All Memphis (recipients of the CDC funding), as well as investigators from Vanderbilt University, Yale University and the national HIV Medicine Association.
“Over the course of 10 years, the study found that there would be decreased use of condoms, decreased use of PrEP [pre-exposure prophylaxis] and decreased HIV testing in the CDC-prioritized populations,” Dr. Agwu said.
“They projected that that would add up to 166 additional HIV transmissions in the CDC-prioritized populations, while preventing zero transmissions in the prioritized populations. It would also lead to 190 additional deaths, 843 life-years lost and a 1,300% increase in costs per deaths prevented among people with HIV.”
Although the study found that outcomes would improve for the newly prioritized populations, the scale of improvement was minimal: 15 deaths would be averted in those groups, but an additional 205 deaths would occur among MSM, transgender women and heterosexual Black women. At 10 years, there would be more people with HIV in total, more undiagnosed people with HIV and fewer virally suppressed people with HIV.
“These findings offer clinical, epidemiological and economic support for the current allocation of resources to CDC-identified populations at greatest risk for HIV and highlight how moving away from such evidence-based policies can do harm,” wrote the study’s authors, noting that the state of Tennessee has a higher HIV incidence and mortality than the U.S. national average. “As policymakers in other states consider the ramifications of rejecting CDC HIV prevention funding, these results can inform evidence-based policy.”
“This is so important,” Dr. Agwu said. “We are in a time when we are facing continuous attacks on HIV funding, and progress that we are making on all of the things we are talking about here could potentially be at risk.”
