{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T02:09:28Z","timestamp":1784167768846,"version":"3.55.0"},"reference-count":51,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2024,6,24]],"date-time":"2024-06-24T00:00:00Z","timestamp":1719187200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute for Child Health and Human Development","doi-asserted-by":"publisher","award":["K08 HD094638-05S1"],"award-info":[{"award-number":["K08 HD094638-05S1"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute for Child Health and Human Development","doi-asserted-by":"publisher","award":["UM2 HD111102"],"award-info":[{"award-number":["UM2 HD111102"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["R01 AI042006"],"award-info":[{"award-number":["R01 AI042006"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["R01 MD011770"],"award-info":[{"award-number":["R01 MD011770"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["P30 AI094189"],"award-info":[{"award-number":["P30 AI094189"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["P30 AI110527"],"award-info":[{"award-number":["P30 AI110527"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000026","name":"National Institute on Drug Abuse","doi-asserted-by":"publisher","award":["R37 DA015612"],"award-info":[{"award-number":["R37 DA015612"]}],"id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000026","name":"National Institute on Drug Abuse","doi-asserted-by":"publisher","award":["DP2 DA049282"],"award-info":[{"award-number":["DP2 DA049282"]}],"id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000025","name":"National Institute of Mental Health","doi-asserted-by":"publisher","award":["R01 MH134724"],"award-info":[{"award-number":["R01 MH134724"]}],"id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,12,17]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>In 2023, Tennessee replaced $6.2\u2005M in US Centers for Disease Control and Prevention (CDC) human immunodeficiency virus (HIV) prevention funding with state funds to redirect support away from men who have sex with men (MSM), transgender women (TGW), and heterosexual Black women (HSBW) and to prioritize instead first responders (FR), pregnant people (PP), and survivors of sex trafficking (SST).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We used a simulation model of HIV disease to compare the clinical impact of Current, the present allocation of condoms, preexposure prophylaxis (PrEP), and HIV testing to CDC priority risk groups (MSM\/TGW\/HSBW); with Reallocation, funding instead increased HIV testing and linkage of Tennessee-determined priority populations (FR\/PP\/SST). Key model inputs included baseline condom use (45%\u201349%), PrEP provision (0.1%\u20138%), HIV testing frequency (every 2.5\u20134.8 years), and 30-day HIV care linkage (57%\u201365%). We assumed Reallocation would reduce condom use (\u22124%), PrEP provision (\u221226%), and HIV testing (\u221247%) in MSM\/TGW\/HSBW, whereas it would increase HIV testing among FR (+47%) and HIV care linkage (to 100%\/90%) among PP\/SST.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Reallocation would lead to 166 additional HIV transmissions, 190 additional deaths, and 843 life-years lost over 10 years. HIV testing reductions were most influential in sensitivity analysis; even a 24% reduction would result in 287 more deaths compared to Current. With pessimistic assumptions, we projected 1359 additional HIV transmissions, 712 additional deaths, and 2778 life-years lost over 10 years.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Redirecting HIV prevention funding in Tennessee would greatly harm CDC priority populations while conferring minimal benefits to new priority populations.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciae243","type":"journal-article","created":{"date-parts":[[2024,6,24]],"date-time":"2024-06-24T18:58:54Z","timestamp":1719255534000},"page":"1458-1467","source":"Crossref","is-referenced-by-count":8,"title":["Projecting the Potential Clinical and Economic Impact of HIV Prevention Resource Reallocation in Tennessee"],"prefix":"10.1093","volume":"79","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8666-5382","authenticated-orcid":false,"given":"Ethan D","family":"Borre","sequence":"first","affiliation":[{"name":"Medical Practice Evaluation Center, Massachusetts General Hospital , Boston, Massachusetts ,","place":["USA"]},{"name":"Division of General Internal Medicine, Massachusetts General Hospital , Boston, Massachusetts ,","place":["USA"]},{"name":"Harvard Medical School , Boston, Massachusetts ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aima A","family":"Ahonkhai","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center , Nashville, Tennessee ,","place":["USA"]},{"name":"Vanderbilt Institute for Global Health, Vanderbilt University Medical Center , Nashville, Tennessee ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyu-young Kevin","family":"Chi","sequence":"additional","affiliation":[{"name":"Medical Practice Evaluation Center, Massachusetts General Hospital , Boston, Massachusetts ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amna","family":"Osman","sequence":"additional","affiliation":[{"name":"Nashville CARES , Nashville, Tennessee ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krista","family":"Thayer","sequence":"additional","affiliation":[{"name":"Friends For All , Memphis, Tennessee ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna K","family":"Person","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center , Nashville, Tennessee ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Weddle","sequence":"additional","affiliation":[{"name":"HIV Medicine Association of the Infectious Diseases Society of America , Arlington, Virginia ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clare F","family":"Flanagan","sequence":"additional","affiliation":[{"name":"Medical Practice Evaluation Center, Massachusetts General Hospital , Boston, Massachusetts ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8832-0866","authenticated-orcid":false,"given":"April C","family":"Pettit","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center , Nashville, Tennessee ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Closs","sequence":"additional","affiliation":[{"name":"Friends For All , Memphis, Tennessee ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mia","family":"Cotton","sequence":"additional","affiliation":[{"name":"Friends For All , Memphis, Tennessee ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8449-222X","authenticated-orcid":false,"given":"Allison L","family":"Agwu","sequence":"additional","affiliation":[{"name":"Division of Pediatric Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine , Baltimore, Maryland ,","place":["USA"]},{"name":"Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine , Baltimore, Maryland ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle S","family":"Cespedes","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai , New York, New York ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea L","family":"Ciaranello","sequence":"additional","affiliation":[{"name":"Medical Practice Evaluation Center, Massachusetts General Hospital , Boston, Massachusetts ,","place":["USA"]},{"name":"Harvard Medical School , Boston, Massachusetts ,","place":["USA"]},{"name":"Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital , Boston, Massachusetts ,","place":["USA"]},{"name":"Harvard University Center for AIDS Research , Cambridge, Massachusetts ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5789-9841","authenticated-orcid":false,"given":"Gregg","family":"Gonsalves","sequence":"additional","affiliation":[{"name":"Public Health Modeling Unit and Department of Health Policy and Management, Yale School of Public Health , New Haven, Connecticut ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily P","family":"Hyle","sequence":"additional","affiliation":[{"name":"Medical Practice Evaluation Center, Massachusetts General Hospital , Boston, Massachusetts ,","place":["USA"]},{"name":"Harvard Medical School , Boston, Massachusetts ,","place":["USA"]},{"name":"Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital , Boston, Massachusetts ,","place":["USA"]},{"name":"Harvard University Center for AIDS Research , Cambridge, Massachusetts ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A David","family":"Paltiel","sequence":"additional","affiliation":[{"name":"Public Health Modeling Unit and Department of Health Policy and Management, Yale School of Public Health , New Haven, Connecticut ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth A","family":"Freedberg","sequence":"additional","affiliation":[{"name":"Medical Practice Evaluation Center, Massachusetts General Hospital , Boston, Massachusetts ,","place":["USA"]},{"name":"Division of General Internal Medicine, Massachusetts General Hospital , Boston, Massachusetts ,","place":["USA"]},{"name":"Harvard Medical School , Boston, Massachusetts ,","place":["USA"]},{"name":"Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital , Boston, Massachusetts ,","place":["USA"]},{"name":"Harvard University Center for AIDS Research , Cambridge, Massachusetts ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7915-4974","authenticated-orcid":false,"given":"Anne M","family":"Neilan","sequence":"additional","affiliation":[{"name":"Medical Practice Evaluation Center, Massachusetts General Hospital , Boston, Massachusetts ,","place":["USA"]},{"name":"Division of General Internal Medicine, Massachusetts General Hospital , Boston, Massachusetts ,","place":["USA"]},{"name":"Harvard Medical School , Boston, Massachusetts ,","place":["USA"]},{"name":"Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital , Boston, Massachusetts 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