Localized economic modeling to optimize public health strategies for HIV treatment and prevention

摘要 艾滋病毒治疗方面的科学进步表明，立即获得 联合抗逆转录病毒疗法(ART)对个人和公共健康都有好处。使用 充分利用抗逆转录病毒疗法，艾滋病毒相关的发病率、死亡率和传播可能会急剧增加。 在人口层面上减少。因此，全球艾滋病毒控制战略的重点已经转向 在抗逆转录病毒疗法中努力“寻找、检测、治疗和留住”艾滋病毒携带者。 关于艾滋病毒护理级联的新研究，一种跟踪数字的简单指标 被感染、确诊、对ART和病毒抑制的个体，已明确控制 艾滋病毒流行的关键在于卫生保健系统在提供和提供服务方面的表现 关心爱滋病患者。然而，作为一种监视工具，它提供的基础是不完整的，可能具有误导性 关于如何分配资金的决定。 美国的艾滋病毒疫情是一组不同的微流行病，主要散布在 城市中心具有不同的潜在流行病和结构条件。这些完全不同的 基础条件要求采取本地化战略，以优化艾滋病毒护理级联。更迭 在这些微流行病中，以及在如何改进艾滋病毒检测和护理方面的证据中， 挑战我们做出明智和及时决策的能力，从而带来最大的健康 为治疗和预防艾滋病毒投入的资源带来的好处。 我们提出了一个新的经济建模框架，以彻底改变艾滋病毒监测。这 框架将确保稀缺资源集中于能够提供 在给定的微流行病中实现最大的性价比。我们将建立一个经过验证的经济模式 生成快速、自动化的证据合成，重点关注最低限度的数据要求 更新模型，并将公共卫生干预新成果的结果整合到 实时疾病监测系统。 改善艾滋病毒检测和抗逆转录病毒疗法的干预措施的实验和观察性研究 参与已证明其在一般和目标人群中的有效性，但 它们在实践中远远没有得到充分利用。针对注射吸毒者的结构性干预(PWID)， 如针头交换和阿片类激动剂疗法(OAT)，已被证明在 这些服务门槛较低的司法管辖区，导致艾滋病毒发病率惊人下降 和疾病负担。我们假设这些干预措施的独特组合将提供最好的 在每一次微流行病中物有所值，最优组合将随着时间的推移而变化 根据潜在的流行趋势和艾滋病毒的科学进步状况 干预研究。 我们将展示我们在美国六个不同的城市环境中的方法 结构状况、物质使用模式和艾滋病毒流行。这个项目是一个创新的项目 翻译研究计划，将加强监督工作并增加影响 艾滋病毒和药物使用障碍的干预研究。

SUMMARY Scientific advances in HIV treatment have demonstrated that immediate access to combination antiretroviral therapy (ART) provides both individual and public health benefits. With sufficient uptake of ART, HIV-related morbidity, mortality and transmission can be drastically reduced at the population-level. As a result, the focus of global HIV control strategies have turned towards efforts to ‘seek, test, treat and retain’ people living with HIV (PLHIV) in ART. Emerging research on the cascade of HIV care, a simple metric tracking numbers of individuals infected, diagnosed, on ART and virally suppressed, has made clear that the control of the HIV epidemic hinges on the performance of health care systems in reaching and delivering care to PLHIV. Yet, as a surveillance tool, it provides an incomplete and possibly misleading basis for decisions on how to allocate funding. The US HIV epidemic is a diverse set of microepidemics, dispersed primarily across large urban centers with different underlying epidemiological and structural conditions. These disparate underlying conditions require localized strategies to optimize the HIV care cascade. Changes over time in these microepidemics, as well as in evidence on how to improve HIV testing and care, challenges our ability to make informed and timely decisions that result in the greatest health benefits for the resources invested in treating and preventing HIV. We propose a novel economic modeling framework to revolutionize HIV surveillance. This framework would ensure scarce resources are focused on interventions that can provide the greatest value for money in a given microepidemic. We will build upon a validated economic model to produce rapid, automated evidence synthesis, focusing on minimal data requirements to update the model, and integrate findings from emerging results of public health interventions into real-time disease surveillance systems. Experimental and observational studies of interventions to improve HIV testing and ART engagement have demonstrated their effectiveness in generalized and targeted populations, yet they are vastly underused in practice. Structural interventions for people who inject drugs (PWID), such as needle exchange and opioid agonist therapy (OAT), have proven incredibly valuable in jurisdictions with low barriers to these services, resulting in staggering declines in HIV incidence and disease burden. We hypothesize that a unique mix of these interventions will provide the best value for money in each microepidemic, and that the optimal combinations will change over time according to underlying epidemic trends and the state of scientific advancement in HIV intervention research. We will demonstrate our approach for six distinct urban settings in the US with disparate structural conditions, substance use patterns, and HIV epidemics. This project is an innovative translational research initiative that will enhance surveillance efforts and increase the impact of interventional research in HIV and substance use disorders.