Modeling the Impact of HIV Prevention Interventions

描述（由申请人提供）：艾滋病毒流行的增长一直是无情的，在人类健康和社会福利方面造成了毁灭性的损失。预防干预措施，包括艾滋病毒疫苗和其他行为和生物医学干预措施的挫折表明，确定有效的预防战略可能比预期的更难以实现。从理论上讲，人们可以进行随机临床试验（RCT）来评估各种有希望的干预策略在降低个人和人群中艾滋病毒发病率方面的效果。然而，出于道德和后勤方面的原因，这是不可行的。长期随机临床试验的一个创新替代方案是使用随机建模，以允许模拟各种干预措施，单独或组合，以评估其对艾滋病毒发病率和流行率的影响，在一系列合理的假设。该提案有以下三个具体目标：目标1：建立一个随机的，基于代理的艾滋病毒传播模型，通过将影响艾滋病毒传播的人群中的性行为结合起来，将传播模型与非常成功的CEPAC US和CEPAC International模型联系起来，以捕获艾滋病毒疾病状态和感染性作为艾滋病毒RNA的函数的影响，在资源有限的情况下和美国，对艾滋病毒传播的治疗耐药性和坚持性进行评估，并在ART推出之前根据南非共和国和美国的数据校准模型。目标2：在南非共和国，评价初级、二级和综合艾滋病毒预防干预措施对人口一级的影响，并在该流行病的影响（艾滋病毒发病率、流行率、预期寿命）、成本和成本效益）方面采取措施。目标3：在美国，评价一级、二级和综合艾滋病毒预防干预措施（单独或组合）对MSM人群水平效果（艾滋病毒发病率、流行率、质量调整预期寿命）、成本和成本效益的影响。 公共卫生相关性：该研究团队在出版和传播研究结果方面有着广泛而可靠的记录，这些研究结果为美国和国际上艾滋病毒护理和实践指南制定的优先事项提供了信息。通过扩展CEPAC治疗模式，并实现上述具体目标，该团队将为世界各地的提供者和政策制定者面临的最关键的艾滋病毒预防政策问题带来创新分析。

DESCRIPTION (provided by applicant): The growth of the HIV epidemic has been relentless, taking a devastating toll in terms of human health and social welfare. Setbacks in prevention interventions, including HIV vaccines and other behavioral and biomedical interventions, suggest that identifying effective prevention strategies may prove even more elusive than anticipated. In theory, one might conduct randomized clinical trials (RCTs) to estimate the efficacy of various promising intervention strategies on reducing HIV incidence among individuals and populations. However, for ethical and logistical reasons this is not feasible. One innovative alternative to long-term, randomized clinical trials is the use of stochastic modeling to allow for the simulation of a variety of interventions, alone and in combination, to assess their impact on HIV incidence and prevalence under a wide array of plausible assumptions. This proposal has the following three specific aims: AIM1: To build a stochastic, agent-based HIV transmission model which captures the population effects of transmission dynamics of HIV by incorporating sexual behaviors within a population that affect HIV transmission, linking the transmission model to the highly successful CEPAC US and CEPAC International models to capture the effects of HIV disease state and infectivity as a function of HIV RNA, treatment resistance, and adherence on HIV transmission in resource limited settings and the US and to calibrate the model to data from both the Republic of South Africa and the US before ART roll out. AIM 2: In the Republic of South Africa, to evaluate the impact of primary, secondary and combination HIV prevention interventions on population level measures of effect (HIV incidence, prevalence, life expectancy), cost and cost-effectiveness) in the epidemic. AIM 3: In the US, to evaluate the impact of primary, secondary and combination HIV prevention interventions either alone or in combination, on population level measures of effect (HIV incidence, prevalence, quality adjusted life expectancy), cost and cost-effectiveness among MSMs. PUBLIC HEALTH RELEVANCE: The assembled research team has an extensive and proven record of publishing and disseminating findings that inform priority-setting in HIV care and practice guideline development, both in the US and internationally. By expanding the CEPAC treatment model, and accomplishing the specific aims described above, the team will bring innovative analysis to the most crucial HIV prevention policy questions that face providers and policy-makers throughout the world.