A decision analytics model to optimize investment in interventions targeting the HIV preexposure prophylaxis cascade of care.
A decision analytics model to optimize investment in interventions targeting the HIV preexposure prophylaxis cascade of care.
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DOI：
10.1097/qad.0000000000002909
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发表时间：
2021-07-15
期刊：
影响因子：
--
通讯作者：
Enns E
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作者：
Jenness SM;Knowlton G;Smith DK;Marcus JL;Anderson EJ;Siegler AJ;Jones J;Sullivan PS;Enns E
在男男性行为者（MSM）中，艾滋病毒暴露前预防（PrEP）使用的推荐水平和实际水平之间仍然存在差距。干预措施可以解决这些差距，但目前尚不清楚公共卫生举措应如何将预防资金投入这些干预措施，以最大限度地发挥其对人口的影响。我们使用了一个随机网络为基础的艾滋病毒传播模型的MSM在亚特兰大地区配对的经济预算优化模型。该模型模拟了MSM参与多达三个真实世界的PrEP级联干预，旨在改善启动，依从性或持久性。主要结局是10年内避免感染。预算优化模型确定了不同预算下的投资组合，从付款人的角度考虑，在给定干预成本的情况下，最大限度地提高了这一结果。从基础的15% PrEP覆盖水平，三种干预措施可以将覆盖率提高到27%，从而在10年内避免12.3%的感染。每种干预措施的吸收是相互依赖的：最大限度地使用坚持和持久性干预措施取决于新的PrEP用户产生的初始干预。随着预算的增加，最佳投资涉及的混合物的启动和持久性的干预，但不坚持干预。如果坚持干预成本减半，最佳投资大致相等的干预措施。通过各种举措对PrEP级联的投资应考虑到集体部署的干预措施的相互作用。鉴于目前的干预效果估计，每项干预措施的总体人口影响可能会随着总预算的增加或干预费用的减少而改善。
Gaps between recommended and actual levels of HIV preexposure prophylaxis (PrEP) use remain among men who have sex with men (MSM). Interventions can address these gaps, but it is unknown how public health initiatives should invest prevention funds into these interventions to maximize their population impact. We used a stochastic network-based HIV transmission model for MSM in the Atlanta area paired with an economic budget optimization model. The model simulated MSM participating in up to three real-world PrEP cascade interventions designed to improve initiation, adherence, or persistence. The primary outcome was infections averted over 10 years. The budget optimization model identified the investment combination under different budgets that maximized this outcome given intervention costs from a payer perspective. From the base 15% PrEP coverage level, the three interventions could increase coverage to 27%, resulting in 12.3% of infections averted over 10 years. Uptake of each intervention was interdependent: maximal use of the adherence and persistence interventions depended on new PrEP users generated by the initiation intervention. As the budget increased, optimal investment involved a mixture of the initiation and persistence interventions, but not the adherence intervention. If adherence intervention costs were halved, the optimal investment was roughly equal across interventions. Investments into the PrEP cascade through initiatives should account for the interactions of the interventions as they are collectively deployed. Given current intervention efficacy estimates, the total population impact of each intervention may be improved with greater total budgets or reduced intervention costs.