Funding Cuts to U.S. HIV Preventive Services Could Lead to Thousands More Cases, Billions in Costs
Assuming that cuts to PrEP programs reduced PrEP coverage by 3.3 per 100 people each year with indications for PrEP over the next decade (eg, effects of discontinuing interventions to increase PrEP awareness, increasing out-of-pocket PrEP costs), HIV diagnosis rates were estimated to increase by, on average, 2.3%.
“This modest decrease in PrEP coverage would be expected to erase all the reductions in HIV transmissions achieved during the past decade,” the study authors wrote.
“Based on analyses of data from a census of US PrEP users including 17,333,732 person-years of time using PrEP, an absolute 3.3% annual reduction in PrEP coverage during the next 10 years (eg, 2023 to 2033) would result in 8,618 avoidable HIV infections, with lifetime medical costs of $3.6 billion (discounted) for treatment,” they added.
Net costs over the decade under this scenario would be $1.4 billion (discounted) and $1.9 billion (undiscounted). Evaluating a scenario of larger cuts to PrEP programs, with estimates of yearly decrease in PrEP coverage of 10 per 100 people with indications for PrEP, resulted in 26,873 HIV infections that failed to be prevented in a decade, with correspondingly higher lifetime medical costs of $11.2 billion (discounted) and $29.0 billion (undiscounted).
“HIV prevention via PrEP improves the health of US residents and can save money in terms of medical costs from the payer perspective,” the researchers wrote. “Moreover, although not considered in this study, cost estimates from the societal perspective would likely show even more cost savings, because most HIV infections occur in younger people.”
They said that consideration of policy changes couldn’t come at a worse time, with advanced PrEP treatments and more in development promising further reductions in HIV infections.
“Disinvestment in PrEP programs will slow the current progress in reducing new infections; disinvestment in PrEP research structures will also destabilize a present (and desperately needed) acceleration in HIV prevention technologies,” they concluded.
Nearly 50% More Infections by 2030
The second study, published in the Annals of Internal Medicine, involved a simulation of HIV transmission and Ryan White clients in 31 high-burden US cities and a survey of clinic directors and administrators to estimate how many new HIV infections could ensue if federal funding cuts disrupted or ended Ryan White services for 18 to 42 months by 2030.
The Ryan White HIV/AIDS Program has provided prevention and treatment services to over half of people with HIV in the United States for 35 years.
A team led by Johns Hopkins researchers modeled four model scenarios were continued services, cessation in July 2025, interruption until January 2027, and interruption until January 2029.
The researchers estimated that ending Ryan White services in July 2025 would result in 75,436 additional infections (95% credible interval [CrI], 19,251 to 134,175 infections) by 2030—a 49% (95% CrI, 12% to 86%) increase. The increases ranged from 9% in Riverside, California, to 110% in Baltimore, Maryland. Eighteen- and 42-month interruptions resulted in 19% and 38% more infections, respectively.
A “conservative” sensitivity analysis using observational studies with lower simulated loss of suppression projected 34,051 excess infections (95% CrI, 23,902 to 45,147 infections).
“The most powerful form of prevention is making sure we treat people with HIV effectively,” senior author Anthony “Todd” Fojo, MD, MHS, of Johns Hopkins, said in a university news release. “Providing medical treatment for HIV is a public health issue in that it is a lifelong condition. With antiretroviral therapy, people with HIV can expect to live a normal lifespan and do not transmit HIV.”
Fojo noted that, if Ryan White funding ends now, the predicted increase in HIV infections in Baltimore by 2030 would easily be the worst among the studied cities. “I’m dismayed to see that Baltimore City’s infections would increase by 110%, meaning infections over the next five years would double,” he said.
Mary Van Beusekom, MS, is a reporter and editor for CIDRAP News. This articleis published courtesy of the University of Minnesota’s Center for Infectious Diseases Research and Policy (CIDRAP).
