Modeling Structural HIV Determinants in Substance Users and related populations

 描述（由申请人提供）：该修订申请提出了数据分析，以模拟组合和结构性干预措施的潜在影响及其成本效益，以优化墨西哥蒂华纳的艾滋病毒预防。自2003年以来，我们在蒂华纳对注射毒品者（PWID）、女性性工作者（FSW）、其客户和男男性行为者（MSM）中动态、新出现的亚流行病进行了定性。为了指导政策制定者和项目规划者，我们将预测单独和组合的艾滋病毒干预措施的不同覆盖范围的影响和成本效益，以确定将艾滋病毒传播降低到低水平的最佳覆盖范围。我们拟议工作的一个创新特点是模拟与天津艾滋病毒感染有关的“上游”结构决定因素（即，警务做法和从事非自愿性工作）。我们的目标是：1）对发生在天津不同高危人群（PWID，MSM，MSM-IDU，FSW，FSW-IDU及其客户）中的重叠艾滋病毒和梅毒流行病进行建模，以确定特定风险群体和性或注射风险行为驱动艾滋病毒传播的程度。2)评估扩大针对特定风险亚组的现有和新型干预措施（例如，SEP、OST、ART和两种现有行为干预措施）覆盖范围的影响和成本效益，以确定控制艾滋病毒传播的最具成本效益的组合干预措施。3)模拟警务实践和监禁对艾滋病毒传播的潜在重要性，以及PEP对改变警务实践和艾滋病毒传播的后续影响。4)为了模拟减少非自愿（即，作为未成年人被强迫/胁迫从事性交易 或成人艾滋病毒传播在蒂华纳。我们来自美国的预防科学家和建模师团队，墨西哥和英国将利用来自8个NIH资助的R 01和相关子研究的主要和次要数据。墨西哥决策者还提供了前所未有的项目数据访问权限。鉴于蒂华纳作为毒品和性交易走廊的位置及其在墨西哥-美国边境的位置，蒂华纳的艾滋病毒流行可能代表墨西哥和中美洲的未来，并可能对美国艾滋病毒流行产生重大影响。结果将对墨西哥和美国的政策和方案产生影响。我们的项目将推动对中低收入国家新出现的艾滋病毒流行病的结构性决定因素和组合预防干预措施的潜在影响进行建模，并响应艾滋病研究办公室2015年的跨NIH计划。

 DESCRIPTION (provided by applicant): This amended application proposes data analyses to model the potential effects of combination and structural interventions and their cost-effectiveness to optimize HIV prevention in Tijuana, Mexico. Since 2003, we have characterized dynamic, emerging sub-epidemics in Tijuana among people who inject drugs (PWID), female sex workers (FSWs), their clients and MSM. To guide policy makers and program planners, we will project the impact and cost-effectiveness of varying coverage of HIV interventions alone and in combination, to determine their optimal coverage for reducing HIV transmission to low levels. An innovative feature of our proposed work is to model `upstream' structural determinants associated with HIV infection in Tijuana (i.e., policing practices and entry into involuntary sex work). Our aims are: 1) To model overlapping HIV and syphilis epidemics occurring among different high risk groups in Tijuana (PWID, MSM, MSM-IDU, FSW, FSW-IDU, and their clients) to ascertain the extent to which HIV transmission is driven by specific risk groups and sexual or injecting risk behaviors. 2) To assess the impact and cost-effectiveness of scaling up coverage of existing and novel interventions (e.g. SEP, OST, ART, and two existing behavioral interventions), targeted at specific risk subgroups, to identify the most cost-effective combinatio intervention package to control HIV transmission. 3) To model the potential importance of policing practices and incarceration on HIV transmission among PWID in Tijuana, and the subsequent impact of a PEP on changing policing practices and HIV transmission. 4) To model the potential impact of reducing involuntary (i.e., forced/coerced) entry into sex trade as a minor or adult on HIV transmission in Tijuana. Our team of prevention scientists and modelers from the U.S., Mexico and the U.K. will utilize primary and secondary data from 8 NIH-funded R01s and related sub-studies in Tijuana. Mexican policy makers have also provided unprecedented access to program data. Given Tijuana's location as a corridor for drug and sex trafficking and its location on the Mexico-US border, Tijuana's HIV epidemic may represent what lies ahead for Mexico and Central America, and may significantly impact the U.S. HIV epidemic. Results will have policy and programmatic implications for Mexico and the U.S. Our project will advance efforts to model the potential impacts of structural determinants and combination prevention interventions on emerging HIV epidemics in lower and middle-income countries, and is responsive to the Office of AIDS Research's Trans-NIH Plan for 2015.