Model shows interventions could narrow life expectancy gap between Black, white MSM
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WASHINGTON — Using a simulation model, researchers estimated that regular testing and improved engagement in care could add more than 3 years to the life expectancy of HIV-positive Black men who have sex with men.
The model estimated that non-Hispanic Black men who have sex with men (MSM) have a life expectancy more than 6 years shorter than white MSM. That gap narrowed with a combined intervention that included annual testing, improved linkage to care and improved viral suppression.
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“Substantial disparities in care exist between Black and white MSM here in the United States. We find that unacceptable,” researcher Katherine M. Rich, MPH, a student at Harvard Medical School, said during a press conference here at IDWeek.
Rich said the goals of the federal Ending the HIV Epidemic in the U.S. initiative — which include reducing the number of new HIV infections by at least 90% by 2030 — “won’t be met until HIV-related disparities are reduced.”
“One of the four key goals of the national HIV strategic plan is to reduce these disparities, and more work is needed to actually develop and implement interventions to do so,” Rich said.
Rich and colleagues used a simulation modeling approach to project the life expectancy from age 15 years of non-Hispanic Black and white MSM living in the U.S. under standard HIV care and then project what the impact would be on their life expectancy if they were tested annually, if 95% were retained in care and if 95% achieved virally suppression.
The model they used — called CEPAC, which stands for Cost-effectiveness of Preventing AIDS Complications — allowed the researchers “to model a cohort of individuals through a lifetime,” Rich explained.
For the study, Rich and colleagues modeled 1 million hypothetical patients in each of the two cohorts — Black and white MSM — beginning the model at age 15 years and simulating the trajectory of HIV disease from infection to diagnosis to engagement and linkage to care.
They used CDC data to estimate the average age of HIV infection in each of the two cohorts, which was around age 27 years for Black MSM and 35 years for white MSM, and time from infection to diagnosis, which was nearly 3 1/2 years for Black MSM and 3 years in the white cohort.
According to a model using CDC data from 2019, life expectancy from age 15 years for people with HIV under the current standard of care was 52.2 years for Black MSM and 58.5 years for white MSM — a difference of 6.3 years.
When the researchers added annual testing to the model, life expectancy increased 0.6 years for Black MSM and 0.3 years for white MSM. Improving retention in care to 95% had the largest benefit of any single strategy, adding 1.4 years for Black MSM and 1 year for white MSM. Increasing the rate of viral suppression added 1.1 and 0.3 years to the two cohorts, respectively.
Adding all three to the model produced even larger benefits, with Black MSM gaining 3.4 years of life and white MSM 1.6 years.
“This underscores the need for equity-focused interventions across the HIV care continuum,” Rich said.
However, she said, bringing levels of testing, treatment and viral suppression up to UNAIDS’ 95-95-95 targets for HIV will be difficult.
“I think we’re dealing with a lot of institutionalized racism and stigma,” Rich said. “These interventions will likely need to look different in different locations — the epidemic looks different in rural vs. urban, southern vs. northern.”
“It really is going to require a lot of investment with community stakeholders, with people on the ground [and] a lot of different types of research — including implementation research — to really focus on what strategies will be most effective,” added senior author Emily P. Hyle, MD MSc, an associate professor of medicine at Harvard Medical School and infectious disease physician at Massachusetts General Hospital in Boston.
References:
- HIV.gov. What is Ending the HIV Epidemic in the U.S.? https://www.hiv.gov/federal-response/ending-the-hiv-epidemic/overview. Updated July 1, 2022. Accessed Oct. 22, 2022.
- Massachusetts General Hospital. The CEPAC model is a computer-based, state-transition, Monte Carlo simulation model of the progression and outcomes of HIV disease. https://www.massgeneral.org/medicine/mpec/research/cpac-model. Accessed Oct. 22, 2022.
- Rich KM, et al. Abstract 798. Presented at: IDWeek; Oct. 19-23, 2022; Washington (hybrid meeting).
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Rich KM, et al. Abstract 798. Presented at: IDWeek; Oct. 19-23, 2022; Washington (hybrid meeting).
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