Modeling Structural HIV Determinants in Substance Users and related populations

 描述(由申请人提供)：这份修改后的申请提出了数据分析，以模拟组合和结构性干预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，我们在提华纳描述了注射吸毒者(PWID)、女性性工作者(FSWs)、她们的客户和男男性接触者(MSM)之间动态、新出现的亚流行病的特征。为了指导政策制定者和计划规划者，我们将预测单独和联合覆盖不同艾滋病毒干预措施的影响和成本效益，以确定它们将艾滋病毒传播减少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提华纳艾滋病毒感染有关的“上游”结构性决定因素(即警务做法和非自愿性工作)。我们的目标是：1)在提华纳的不同高危人群(PWID、MSM、MSM-IDU、FSW、FSW-IDU及其客户)之间建立重叠的HIV和梅毒流行模型，以确定特定的风险群体和性或注射危险行为在多大程度上推动了HIV的传播。2)评估扩大针对特定风险亚群的现有和新干预措施(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方案。3)模拟警察做法和监禁对提华纳PWID中艾滋病毒传播的潜在重要性，以及PEP随后对改变警察做法和艾滋病毒传播的影响。4)模拟减少作为未成年人的非自愿(即强迫/强迫)进行性交易的潜在影响 或在提华纳感染艾滋病毒的成年人。我们来自美国、墨西哥和英国的预防科学家和模型师团队将利用来自美国国立卫生研究院资助的8个R01和提华纳相关子研究的主要和次要数据。墨西哥政策制定者还提供了前所未有的访问项目数据的机会。鉴于蒂华纳作为毒品和性交易走廊的位置，以及它位于墨西哥和美国边境的位置，蒂华纳的艾滋病毒疫情可能代表着墨西哥和中美洲的未来，并可能对美国的艾滋病毒疫情产生重大影响。研究结果将对墨西哥和美国产生政策和规划上的影响。我们的项目将推进结构性决定因素和联合预防干预措施对中低收入国家新出现的艾滋病毒流行的潜在影响的建模工作，并响应艾滋病研究办公室的2015年跨国家卫生研究院计划。

 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.