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

 描述(由申请者提供)：美国食品和药物管理局(FDA)于2012年批准了第一个非处方药家庭使用艾滋病毒检测。公共卫生部门已经开始实施计划，以增加它们的使用；然而，这些检测对男男性行为者(MSM)中艾滋病毒流行的潜在影响尚不清楚。这项研究的目的是为公共卫生方法提供信息，以促进针对不同MSM人群的安全和有效的家庭使用艾滋病毒检测战略。如果MSM使用家用艾滋病毒检测，否则他们不会进行检测，或者如果他们提高了检测、诊断和治疗的比率，那么家庭使用的艾滋病毒检测可能会降低艾滋病毒的发病率。然而，如果男性用家庭测试取代以诊所为基础的测试，家庭使用测试可能会增加传播，因为可用测试的窗口期相对较长，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测试。如果在家中检测呈阳性的男性不及时寻求护理并开始抗逆转录病毒疗法，家庭使用检测也可能对感染者的健康产生负面影响，并对艾滋病毒预防构成挑战。男性可能会在性行为前对性伴侣进行家庭使用测试，以决定是否发生性行为以及如何发生性行为。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适应，这种性点检测可能是有益的，但如果男性基于关于血清状态的错误信息而放弃避孕套，则可能会增加艾滋病毒风险。使用来自美国西雅图和亚特兰大两个不同流行病学环境的数据，我们将使用数学模型来估计在个人和伙伴层面上家庭使用艾滋病毒检测的不同策略如何影响艾滋病毒发病率。首先，我们将开发一系列参数来代表MSM的新的和不同种类的HIV检测策略，并调整、扩展和验证基于随机网络的HIV传播模型，以解释西雅图、华盛顿州和佐治亚州亚特兰大的MSM的家庭使用检测策略和血清适应行为。其次，我们将使用这些模型来确定最有效的个人家庭使用艾滋病毒检测策略，以提高对艾滋病毒感染的认识，并在两种环境下降低男男性行为者的艾滋病毒发病率。第三，我们将预测家庭使用的性别点艾滋病毒检测策略对西雅图和亚特兰大男男性行为者对艾滋病毒感染和艾滋病毒发病率的二元水平认识的影响。在这项提案中，我们的模型类似于虚拟实验室：一种实用且具有成本效益的方式来检查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景。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，如果这样的倡议得到保证的话。

 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.