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

项目摘要/摘要 艾滋病毒/艾滋病是儿童和青少年发病和死亡的主要原因，这是众所周知的。 儿童(出生到9岁)和青少年(10-14岁)的艾滋病毒护理和治疗落后 对成年人来说，这导致了无数次行动的呼吁。尽管全球对消除新的艾滋病毒达成了共识 在这些年龄段的感染中，针对目标的进展评估受到阻碍，正如目前的估计所做的那样 包括大量本地可用数据。此外，青少年中新的艾滋病毒感染 没有被量化。这些年龄段的全球艾滋病毒负担目前由两个群体估计：全球 疾病负担(GBD)研究和联合国艾滋病规划署，这两项研究目前都假设这些人没有新的艾滋病毒感染 15岁以下。两组都使用Spectrum儿童模型，该模型在很大程度上依赖于估计的艾滋病毒流行率在 成年妇女，预防母婴传播的治疗，以及其他估计 儿童和青少年的艾滋病毒负担。其中一个假设是，新的艾滋病毒感染在 15岁以下的人只有一个来源--母婴传播--假设没有性行为和 青少年艾滋病毒零发病率。除了行为因素，有证据表明，艾滋病毒的风险 传播受到生物医学因素的影响(例如艾滋病毒检测率、抗逆转录病毒治疗覆盖率)和 结构性因素(例如国民财富、受教育机会、保健质量和机会)。然而，在那里 没有系统地研究这些因素对艾滋病毒流行轨迹的影响。给定 这一流行病的复杂性和促成因素的相互作用，需要更多的数据和分析，以 了解这些因素的相对影响。开发三角测量新获取的数据源的方法 对于加强对这一流行病的驱动因素的了解以及产生更有力的艾滋病毒负担至关重要 对儿童和青少年的估计。因此，这项研究的目标是解决现有的限制 方法通过三角测量经验数据来源，以产生更准确和全面的估计 儿童艾滋病毒负担，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- 曾经估计过青少年中新的艾滋病毒感染，并将这些结果纳入一项 交互式可视化平台，帮助关键利益相关方了解当前和预计的未来负担 儿童和青少年在不同情况下的艾滋病毒/艾滋病。该项目由四个具体的 目标：(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 在儿童(0-9岁)中；(2)估计青少年(10-14岁)中的新感染；(3)量化 生物医学、行为和结构因素对艾滋病传播概率和死亡率的影响 儿童和青少年；和(4)通过以下途径预测儿童和青少年未来的艾滋病毒负担 2040基于发病率、流行率和死亡率以及暴露于风险和保护因素的当前趋势。

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.