Key model parameters
| Variable | Value | Sensitivity analysis | References |
|---|---|---|---|
| HIV care continuum dynamics used in base-case scenario | |||
| Percentage HIV testing in past 12 months among general population | 3.2% | 1–7.5% | 22 |
| Per cent HIV testing in past 12 months among high-risk groups | 17–31.8% | 5–60% | 22 |
| Percentage of newly diagnosed HIV patients with early linkage to care* | 50–80% | 25–100% | 10 23 |
| Per cent of PLWH in care who become lost to follow-up yearly | 15–19.5% | 10–39% | 10 11 24 25, assumption |
| Median time spent lost to follow-up before return to care | 3 years | 2–4 years | 10 11 24 25, assumption |
| Percentage of PLWH who develop resistance to first-line ART after disengagement | 25% | 10–50% | 26, assumption |
| Per cent of PLWH on ART who develop resistance to ART | 7–10% yearly | 2–30% yearly | 11 27 28 |
| Median time after ART failure before treatment modification | 1.25–2 years | 8 months—20 years | 27 28 |
| Median time after linkage to care before initiation of ART (irrespective of CD4 count)† | 3 months | 2–6 months | 13 |
| HIV care continuum dynamics used in 90-90-90 scenario | |||
| Per cent HIV testing in past 12 months among general population | 20% | 15–25% | Calibrated |
| Per cent HIV testing in past 12 months among high-risk groups | 100% (ie, annual) | 80–100% | Calibrated |
| Per cent of PLWH in care who become lost to follow-up yearly | 10–13% | 7.5–16.25% | Calibrated |
| Median time spent lost to follow-up before return to care | 1 year | 8–15 months | Calibrated |
| Median time after ART failure before treatment modification | 4 months | 2–6 months | Calibrated |
| Median time after linkage to care before initiation of ART (irrespective of CD4 count) | 3 months | 2–6 months | Calibrated |
*Patients without early linkage (ie, linkage within 3 months of diagnosis) could still engage in care at a later time.
†We modelled ART initiation rates based on recent guidance that recommends initiation of ART irrespective of CD4 count, though this may not reflect current policies in India.13 ,29 ,30 We thus conducted in our sensitivity analysis an alternative scenario in which India would continue a policy of deferred ART initiation (at CD4 ≤350 cells/mm3; see the Results section).
ART, antiretroviral therapy; PLWH, persons living with HIV.