Impact of Mass Incarceration on HIV Acquisition for the Female Partner: An Agent-based Modeling Study of Philadelphia

项目摘要 据推测，大规模监禁是异性恋、非洲裔和非裔美国人感染艾滋病毒的主要原因。 美国女人监禁可以增加参与艾滋病毒风险行为（包括同时发生性行为） 伴侣关系，交易性行为和无避孕套的性行为）对于被监禁的人和他们的性行为来说， 伴侣和囚犯感染艾滋病毒的可能性大约是一般人的五倍。 人口然而，目前尚不清楚大规模监禁如何影响艾滋病毒的传播和流行， 人口水平。本研究的目的是：1）估计艾滋病毒传播的比例 非裔美国妇女之间的事件归因于男性性伴侣的监禁使用城市的 费城作为一个案例研究; 2）确定治疗作为预防（TasP）和预防（TasP）的有效性。 有监禁史的异性恋夫妇的暴露预防（PrEP）处方策略 根据选定的假设（即艾滋病毒载量，伴侣数量）， 监禁。 使用一种新的复杂系统方法，称为基于代理的建模，基于人口的模型将 在一个动态性接触网络中模拟艾滋病毒的逐月传播， 2005-2015年生活在费城的艾滋病毒高风险美国异性恋男性和女性。在 为了估计可归因于监禁的艾滋病毒传播事件的比例， 计算：1）艾滋病毒事件，流行和死亡病例数; 2）艾滋病毒感染率， 妇女和男性伴侣被监禁的妇女;以及3）艾滋病毒发病率增加的百分比， 患病率和死亡率的增加可归因于监禁率增加一个单位。的有效性 假设的预防方案（即，每次流行期间，所有血清不一致夫妇的PrEP处方 阶段将通过在预先规定的时间间隔内避免的新的HIV感染的分数来估计（例如，二五 10年的时间跨度）。该模型将基于费城收集的监测数据 公共卫生部以及经验文献有关艾滋病毒的危险行为与一个 监禁的历史。将进行广泛的模型校准和验证程序， 鲁棒性并确保拟合优度。 这项研究将是第一个估计艾滋病毒传播事件的比例在非洲裔美国人 并确定最大限度地减少艾滋病毒传播的战略 由于社区一级的监禁。该项目的成果为有针对性的预防铺平了道路， 确定感染艾滋病毒风险最高的妇女，以及采取何种干预战略最有效， 降低美国城市艾滋病的总体发病率。

PROJECT SUMMARY Mass incarceration has been hypothesized to be a major driver of HIV acquisition for heterosexual, African American women. Incarceration can increase engagement in HIV risk behaviors (including concurrent sexual partnerships, transactional sex, and condomless sex) for both the incarcerated person and their sexual partners and inmates are approximately five times as likely to be HIV-infected compared to the general population. However, it is not known how mass incarceration impacts HIV transmission and prevalence at the population-level. The objectives of the proposed study are: 1) to estimate the proportion of HIV transmission events among African American women attributable to a male sexual partner’s incarceration using the city of Philadelphia as a case study; and 2) to determine the effectiveness of treatment as prevention (TasP) and pre- exposure prophylaxis (PrEP) prescription strategies for heterosexual couples with a history of incarceration under selected assumptions (i.e. HIV viral load, number of partners) in preventing transmission attributable to incarceration. Using a novel complex systems approach known as agent-based modeling, a population-based model will simulate HIV transmission month-to-month in a dynamic, sexual-contact network representing African American heterosexual men and women at high-risk of HIV living in the city of Philadelphia from 2005-2015. In order to estimate the proportion of HIV transmission events attributable to incarceration, the following will be calculated: 1) the number of HIV incident, prevalent, and mortality cases; 2) HIV incidence rates among all women and those with an incarcerated male partner; and 3) the percentage increase in HIV incidence, prevalence, and mortality attributable to a one unit increase in the rate of incarceration. The effectiveness of hypothetical prevention scenarios (i.e., PrEP prescription for all serodiscordant couples) during each epidemic phase will be estimated by the fraction of new HIV infections averted over pre-specified intervals (e.g., 2, 5, and 10-year time horizons). The model will be based on surveillance data collected by the Philadelphia Department of Public Health as well as empirical literature regarding HIV risk behaviors associated with a history of incarceration. Extensive model calibration and validation procedures will be conducted to test robustness and ensure goodness of fit. This study will be the first to estimate the proportion of HIV transmission events among African American women attributable to mass incarceration and identify strategies that maximize reductions in HIV transmission due to incarceration at the community level. The results of this project pave the way for targeted prevention by identifying women at highest risk of HIV acquisition and what intervention strategies are most effective in decreasing overall HIV incidence in an urban, U.S. setting.