What Will It Take to End HIV in the United States? : A Comprehensive, Local-Level Modeling Study.
What Will It Take to End HIV in the United States? : A Comprehensive, Local-Level Modeling Study.
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DOI：
10.7326/m21-1501
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发表时间：
2021-11
影响因子：
39.2
通讯作者：
Shah M
中科院分区：
文献类型：
--
作者：
Fojo AT;Schnure M;Kasaie P;Dowdy DW;Shah M
结束艾滋病毒流行(EHE)倡议的目标是在10年内将艾滋病毒感染事件减少90%。为实现这一点所需的干预力度对当地流行病尚不清楚。评估城市一级艾滋病毒干预措施的效果。建立和校准了按年龄、种族、性别和HIV危险因素分层的城市水平HIV传播的分区模型。32个优先都市统计区域(MSA)。每个MSA中的模拟种群。艾滋病毒检测和暴露前预防(PrEP)对艾滋病毒高危人群的覆盖，以及对确诊艾滋病毒感染者的病毒抑制。主要结果是预计从2020年到2030年事件案例减少。在没有干预的情况下，所有32个MSA的艾滋病毒发病率预计将下降19%。到2030年，在整个人口中适度增加检测(每年1.25倍)、PrEP覆盖率(5个百分点)和病毒抑制(10个百分点)可实现34%至67%的减少。25%的PrEP覆盖率，平均每年两次测试，以及90%的年轻黑人和西班牙裔男男性行为者(MSM)的病毒抑制取得了类似的下降(13%到68%)。包括所有男男性接触者和注射吸毒者，可将发病率降低48%至90%。32个MSA中有13个可以通过包括异性恋者在内的大规模干预措施将艾滋病毒发病率降低90%以上。具有特定位置结果的Web应用程序公开可用(www.jheem.org)。新冠肺炎大流行没有得到代表。通过大量投资，艾滋病毒发病率的大幅下降是可以实现的，但在大多数地区，实现EHE目标将是困难的。提出了一个能帮助政策制定者在当地环境中最大化影响的互动模型。美国国立卫生研究院。在最初认识到艾滋病毒感染40年后，尽管制定了高度有效的预防和治疗方法，但艾滋病毒感染仍在美国造成严重的发病率和死亡率。结束艾滋病毒流行倡议的雄心勃勃的目标是在未来10年内将艾滋病毒感染事件减少90%。开发了一个互动模式，以协助政策制定者确定地方一级干预措施的优先次序，以实现这一目标。
The Ending the HIV Epidemic (EHE) initiative aims to reduce incident HIV infections by 90% over a span of 10 years. The intensity of interventions needed to achieve this for local epidemics is unclear. To estimate the effect of HIV interventions at the city level. A compartmental model of city-level HIV transmission stratified by age, race, sex, and HIV risk factor was developed and calibrated. 32 priority metropolitan statistical areas (MSAs). Simulated populations in each MSA. Combinations of HIV testing and preexposure prophylaxis (PrEP) coverage among those at risk for HIV, plus viral suppression in persons with diagnosed HIV infection. The primary outcome was the projected reduction in incident cases from 2020 to 2030. Absent intervention, HIV incidence was projected to decrease by 19% across all 32 MSAs. Modest increases in testing (1.25-fold per year), PrEP coverage (5 percentage points), and viral suppression (10 percentage points) across the population could achieve reductions of 34% to 67% by 2030. Twenty-five percent PrEP coverage, testing twice a year on average, and 90% viral suppression among young Black and Hispanic men who have sex with men (MSM) achieved similar reductions (13% to 68%). Including all MSM and persons who inject drugs could reduce incidence by 48% to 90%. Thirteen of 32 MSAs could achieve greater than 90% reductions in HIV incidence with large-scale interventions that include heterosexuals. A web application with location-specific results is publicly available (www.jheem.org). The COVID-19 pandemic was not represented. Large reductions in HIV incidence are achievable with substantial investment, but the EHE goals will be difficult to achieve in most locations. An interactive model that can help policymakers maximize the effect in their local environments is presented. National Institutes of Health. Forty years after its initial recognition, and despite the development of highly effective approaches to prevention and treatment, HIV infection continues to cause major morbidity and mortality in the United States. The Ending the HIV Epidemic initiative has as its ambitious goal the reduction of incident HIV infections by 90% over the next 10 years. An interactive model was developed to assist policymakers in prioritizing interventions at the local level to achieve this goal.