The Potential Effect of Ending CDC Funding for HIV Tests: A Modeling Study in 18 States.

Background: Timely HIV diagnosis and treatment is critical to preventing transmission. The US Centers for Disease Control and Prevention (CDC) provides funding for HIV testing to local health departments and community organizations. We sought to estimate the number of additional HIV infections that would result from ending or interrupting CDC funding for HIV tests in US states. Methods: We used a validated model of HIV transmission to simulate HIV epidemics in 18 US states. We projected incidence forward under three scenarios where all CDC-funded HIV testing ends in October 2025 and (1) never resumes, (2) returns to previous levels between January and December 2027, and (3) returns from January to December 2029. We calculated the excess incident HIV infections compared to a scenario where CDC-funded testing continues uninterrupted. Results: If CDC funding for HIV tests were to end on October 1, 2025, we project 12,719 additional HIV infections across 18 states by 2030 (95% Credible Interval 4,547 to 21,896) - an increase of 10%. The projected effects varied by state, ranging from a 2.7% increase in Washington (1.0 to 4.7%) to a 29.9 increase in Louisiana (9.4 to 59.9%). States that perform more CDC-funded tests and states with more rural HIV epidemics were projected to see greater rises in incidence. Conclusions: Disruptions to CDC-funded HIV testing would substantially increase new infections, particularly in states with more rural epidemics. These findings demonstrate the value of the CDC's HIV testing activities in curbing the spread of HIV in the US.