Abstract
Objectives: To evaluate the potential contributions
of routine opt-out testing (ROOT) in clinical settings and preexposure
prophylaxis (PrEP) on achieving Ending the HIV Epidemic in the U.S. (EHE) incidence
reduction goals in the South.
Design: Simulation Study
Methods:
An agent-based epidemic projection model simulated adherence to the CDC’s ROOT
guidelines. Simulations were informed by literature reviews, the National
Survey of Family Growth and ARTnet. Interventions included ROOT in Community
Health Center (CHC) and Emergency Departments (ED) alone and in combination.
PrEP was modeled as either persistent at 2019 levels or expanding consistent
with historical trends.
Results: ROOT in CHCs and EDs averted 13.9%
(95%SI: -15.5, 42.4) of new infections and increased the proportion of persons
with HIV (PWH) who were aware of their status to 94.4% (95%SI: 92.8, 95.4). In
conjunction with the ongoing expansion of PrEP the proportion diagnosed
increased from 84.8% at baseline to 95.1% (95% SI: 93.9, 96.4) and 23.3% (95%
SI: -7.9, 50.6) of new infections were averted, reducing the annual incidence
rate by 42.4% compared to the baseline scenario.
Conclusions: In our analysis, ROOT coupled with the
ongoing expansion of PrEP could avert almost a quarter of new infections over 8
years. While short of the overall EHE goal of 90%, it represents substantial
potential progress for a low-cost and low-barrier intervention. ROOT also provides
a method for identifying PWH who are undiagnosed both in and out of priority
populations, those out of care, and individuals reluctant to seek screening.