Quantification of HIV burden and the biomedical, structural, and behavioral factors influencing HIV/AIDS among children and young adolescents

量化艾滋病毒负担以及影响儿童和青少年艾滋病毒/艾滋病的生物医学、结构和行为因素

• 批准号: 10159147
• 负责人: Hmwe Hmwe Kyu
• 金额: $ 69.67万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-03-05 至 2026-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10159147
• 关键词: AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Address; Adolescent; Adult; African; Age; Automobile Driving; Behavioral; Big Data; Birth; Caring; Cessation of life; Child; Childhood; Consensus; Country; Data; Data Analyses; Data Sources; Education; Epidemic; Exposure to; Fibrinogen; Future; Goals; HIV; HIV Infections; Health; Human immunodeficiency virus test; Incidence; Infection; Intervention; Link; Location; Measures; Methods; Modeling; Monitor; Morbidity - disease rate; Policies; Population; Prevalence; Prevention; Probability; Risk; Risk Behaviors; Risk Factors; Role; Series; Sex Behavior; Sexual Partners; Source; Structure; Substance abuse problem; Time; Vertical Disease Transmission; Visualization; Visualization software; Woman; Work; age group; antiretroviral therapy; base; burden of illness; condoms; diverse data; health care quality; insight; mortality; pediatric human immunodeficiency virus; protective factors; rate of change; sex; sexual debut; statistics; tool; transmission process; trend

PROJECT SUMMARY/ABSTRACT HIV/AIDS is a leading cause of morbidity and mortality among children and adolescents, and it is well recognized that HIV care and treatment among children (birth to 9 years) and young adolescents (10-14 years) lags behind that of adults, leading to numerous calls to action. Despite a global consensus toward eliminating new HIV infections in these age groups, assessing progress against targets is impeded, as current estimates do not include substantial amounts of locally-available data. Additionally, new HIV infections in young adolescents have not been quantified. The global HIV burden in these age groups is currently estimated by two groups: the Global Burden of Disease (GBD) study and UNAIDS, both of which currently assume no new HIV infections for those under 15. Both groups use the Spectrum child model, which relies largely on estimated HIV prevalence among adult women, treatment for prevention of mother-to-child transmission, and other assumptions to estimate the HIV burden among children and young adolescents. One of the assumptions is that new HIV infections among those under 15 come from only one source – mother-to-child transmission – assuming no sexual activity and zero HIV incidence in young adolescents. In addition to behavioral factors, evidence shows that the risk of HIV transmission is influenced by biomedical factors (e.g., HIV testing rates, antiretroviral therapy coverage) and structural factors (e.g., national wealth, access to education, health care quality and access). However, there has been no systematic study of the impact of these factors on the trajectory of the HIV epidemic. Given the complexity of the epidemic and the interplay of contributing factors, additional data and analyses are needed to understand the relative impact of these factors. Developing methods to triangulate newly acquired data sources is crucial to enhancing understanding of the drivers of the epidemic, and to generating more robust HIV burden estimates for children and adolescents. Accordingly, the goal of this study is to address the limitations of existing methods by triangulating empirical data sources to produce more accurate and comprehensive estimates of pediatric HIV burden, including an understanding of how biomedical, behavioral, and structural factors impact the burden among children and adolescents. Our proposal advances beyond existing work by providing the first- ever estimates of new HIV infections among young adolescents, and by incorporating these results into an interactive visualization platform to help key stakeholders understand the current and projected future burden of HIV/AIDS among children and adolescents under different scenarios. This project is comprised of four Specific Aims: (1) Incorporate currently unused data sources to estimate mother-to-child transmission and HIV burden among children (0-9 years); (2) Estimate new infections among young adolescents (10-14 years); (3) Quantify the impact of biomedical, behavioral, and structural factors on HIV transmission probabilities and mortality among children and young adolescents; and (4) Forecast future burden of HIV among children and adolescents through 2040 based on current trends in incidence, prevalence, and mortality, and exposure to risk and protective factors.

项目总结/摘要 艾滋病毒/艾滋病是儿童和青少年发病率和死亡率的主要原因，这一点已得到广泛承认 儿童（出生至9岁）和青少年（10至14岁）的艾滋病毒护理和治疗滞后， 成年人，导致许多呼吁采取行动。尽管全球一致同意消除新的艾滋病毒 这些年龄组的感染，评估目标进展情况受到阻碍，因为目前的估计数没有 包括大量本地可用数据。此外，青少年中的新艾滋病毒感染者 没有被量化。这些年龄组的全球艾滋病毒负担目前按两组估计： 疾病负担研究和联合国艾滋病规划署，这两个机构目前都假设这些人没有新的艾滋病毒感染。 15岁以下这两个群体都使用了“频谱儿童模型”，该模型在很大程度上依赖于估计的艾滋病毒感染率， 成年妇女、预防母婴传播的治疗以及估计 儿童和青少年的艾滋病毒负担。其中一个假设是， 15岁以下的人只有一个来源-母婴传播-假设没有性活动， 青少年艾滋病毒感染率为零。除了行为因素外，有证据表明， 传播受生物医学因素的影响（例如，艾滋病毒检测率、抗逆转录病毒疗法覆盖率）和 结构因素（例如，国家财富、受教育机会、保健质量和机会）。但 目前还没有系统研究这些因素对艾滋病毒流行轨迹的影响。鉴于 鉴于这一流行病的复杂性和各种促成因素的相互作用，需要更多的数据和分析， 了解这些因素的相对影响。制定三角测量新获得的数据源的方法 对于加强对这一流行病的驱动因素的理解和产生更大的艾滋病毒负担至关重要 儿童和青少年的估计数。因此，本研究的目标是解决现有的局限性， 方法，通过对经验数据源进行三角测量， 儿科艾滋病毒负担，包括了解生物医学，行为和结构因素如何影响 儿童和青少年的负担。我们的建议超越了现有的工作，提供了第一个- 青少年中新的艾滋病毒感染的估计，并将这些结果纳入一个 交互式可视化平台，以帮助关键利益相关者了解当前和预计的未来负担， 不同情况下儿童和青少年的艾滋病毒/艾滋病。该项目由四个具体的 目的：（1）纳入目前未使用的数据来源，以估计母婴传播和艾滋病毒负担 （2）估计青少年（10-14岁）的新感染人数;（3）量化 生物医学，行为和结构因素对艾滋病毒传播概率和死亡率的影响， 儿童和青少年;以及（4）预测儿童和青少年未来的艾滋病毒负担， 根据目前的发病率、患病率和死亡率趋势，以及暴露于风险和保护因素，预测2040年。