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Mathematical models to inform effective home-use HIV testing strategies for MSM

为 MSM 提供有效的家庭 HIV 检测策略的数学模型

基本信息

批准号：
9102129
负责人：
SUSAN LYNN CASSELS
金额：
$ 21.9万
依托单位：
UNIVERSITY OF CALIFORNIA SANTA BARBARA
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-07-05 至 2018-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9102129
关键词：
AIDS prevention Accounting Acute Address Affect Anus Awareness Behavior Cities Clinic Clinical Trials Design Data Data Analyses Decision Making Diagnosis Effectiveness Effectiveness of Interventions Epidemic Epidemiology Frequencies HIV HIV Infections HIV risk Health Home environment Human immunodeficiency virus test Incidence Individual Infection Intervention Modeling Network-based Outcome Persons Population Population Heterogeneity Public Health Quality of Care Race Research Risk Risk Behaviors Running Sexual Partners Subgroup Techniques Testing Time United States Food and Drug Administration Work antiretroviral therapy base behavior test care seeking condoms cost effective high risk improved man mathematical model men men who have sex with men network models novel outreach programs public health intervention racial disparity randomized trial sex tool transmission process uptake virtual laboratory

项目摘要

DESCRIPTION (provided by applicant): The U.S. Food and Drug Administration (FDA) approved the first over-the-counter home-use HIV test in 2012. Public health departments have started to implement programs to increase their use; however, the potential impact of these tests on the HIV epidemic among men who have sex with men (MSM) is unknown. The aim of this research is to inform public health approaches to promote safe and effective home-use HIV testing strategies for diverse populations of MSM. Home-use HIV tests may reduce HIV incidence if used by MSM who would otherwise not test or if they increase rates of testing, diagnosis and treatment. However, home-use tests may increase transmission if men replace clinic-based tests with home-use tests because the relatively long window period of available tests can result in false-negative tests during acute infection when HIV-infected persons are most infectious. Home-use tests may also negatively impact the infected individual's health and pose a challenge for HIV prevention if men who test positive at home do not seek care and initiate antiretroviral therapy (ART) in a timely manner. Men may use home-use tests with sex partners prior to sex to make decisions about whether and how to have sex [5]. Such point-of-sex testing may be beneficial if partners test more often and seroadapt based on more accurate information but may increase HIV risk if men forgo condoms based on incorrect information about serostatus. Using data from two different epidemiologic settings in the U.S., Seattle and Atlanta, we will use mathematical models to estimate how different strategies of home-use HIV testing at the individual and partnership levels affects HIV incidence. First, we will develop a se of parameters to represent novel and heterogeneous HIV testing strategies for MSM, and adapt, expand, and validate a stochastic network-based HIV transmission model to account for home-use testing strategies and seroadaptive behavior for MSM in Seattle, WA and Atlanta, GA. Second, we will use the models to identify the most effective individual home-use HIV testing strategies to increase awareness of HIV infection and reduce HIV incidence among MSM in the two settings. Third, we will predict the impact of home-use point-of-sex HIV testing strategies on dyadic-level awareness of HIV infection and HIV incidence among MSM in Seattle versus Atlanta. In this proposal, our models are akin to a virtual laboratory: a practical and cost-effective way to examine the scenarios under which home-use testing can effectively reduce HIV incidence in diverse high-risk populations. Moreover, our models can support the design of clinical trials to test the effectiveness of home-use HIV testing interventions if such an initiatie is warranted.

描述（由申请人提供）：美国食品和药物管理局（FDA）于2012年批准了第一个非处方家用HIV检测。公共卫生部门已开始实施计划，以增加其使用;然而，这些测试对艾滋病毒流行的男男性行为者（MSM）的潜在影响是未知的。本研究的目的是告知公共卫生方法，以促进安全和有效的家庭使用的艾滋病毒检测策略，为不同的男男性行为者人群。家庭使用的艾滋病毒检测可能会降低艾滋病毒的发病率，如果使用的男男性行为者谁否则不会测试或如果他们增加测试，诊断和治疗率。然而，如果男子用家用检测取代诊所检测，家用检测可能会增加传播，因为可用检测的窗口期相对较长，在艾滋病毒感染者传染性最强的急性感染期间可能导致假阴性检测。如果在家中检测呈阳性的男子不及时寻求护理和开始抗逆转录病毒治疗，家用检测也可能对受感染者的健康产生负面影响，并对艾滋病毒预防工作构成挑战。男性可以在发生性行为之前与性伴侣进行家用测试，以决定是否以及如何发生性行为[5]。如果伴侣更频繁地进行检测，并根据更准确的信息进行血清学调整，这种性点检测可能是有益的，但如果男性根据有关血清学状况的不正确信息放弃避孕套，则可能增加艾滋病毒风险。使用来自美国两个不同流行病学环境的数据，在西雅图和亚特兰大，我们将使用数学模型来估计在个人和伴侣水平上家庭使用的HIV检测的不同策略如何影响HIV发病率。首先，我们将开发一系列参数来代表新的和异质性的艾滋病毒检测策略的男男性接触者，并适应，扩大，并验证一个随机的基于网络的艾滋病毒传播模型，占家庭使用的检测策略和血清适应性行为的男男性接触者在西雅图，华盛顿州和亚特兰大，GA。第二，我们将使用这些模型来确定最有效的个人家用艾滋病毒检测策略，以提高对艾滋病毒感染的认识，并减少艾滋病毒的发病率在男男性行为者在这两个环境。第三，我们将预测在西雅图与亚特兰大的MSM中，家庭使用的性点HIV检测策略对HIV感染和HIV发病率的二元水平认识的影响。在这项提案中，我们的模型类似于一个虚拟实验室：一种实用且具有成本效益的方式来研究家庭使用检测可以有效降低不同高危人群中艾滋病毒发病率的情况。此外，我们的模型可以支持临床试验的设计，以测试家庭使用的艾滋病毒检测干预措施的有效性，如果这样的初始是必要的。