Diagnosing and preventing HIV infection in adolescents and young adults in the US: clinical impact and cost-effectiveness

项目摘要/摘要 13-24岁青年中新感染的艾滋病毒占美国所有新感染艾滋病毒的22%。多过 在美国，已经有60,000名青少年和年轻人(Aya)感染了艾滋病毒，并出现了新的感染病例 在很大程度上促进了艾滋病毒的传播。艾滋病在美国的流行需要新的方法来应对 艾滋病毒诊断和预防，同时考虑到卫生保健提供和研究方面的挑战 Aya与艾滋病毒一起生活并面临感染艾滋病毒的风险。计算机模拟健康政策模型可以增加大量 通过预测超出临床时间范围的结果对临床试验和观察性研究的价值 学习。这对阿亚来说尤其重要，在她身上，艾滋病毒感染和治疗的影响可能不会 已经表现了很多年了。这一指导临床科学家研究职业发展奖将允许 获奖者是马萨诸塞州综合医院的传染病内科医生，以发展研究生涯 使用建模方法和成本-效果分析来评估当前HIV的关键问题 美国艾滋病的预防和筛查。减少突发艾滋病毒感染，改进艾滋病毒筛查，优化 艾滋病毒暴露前预防服务，以及评估艾滋病毒暴露前预防效果- 国立卫生研究院艾滋病研究办公室(2018年目标)和NICHD(2017年新研究优先事项)的优先领域。 与受艾滋病毒影响的阿亚病毒的国家研究合作，该项目将开发一种新的、全面的 阿亚县艾滋病防治卫生政策模式。该模型将反映年龄-以及 特定于发育的Aya模式的寻求护理行为，包括对护理的投入和坚持 到药物治疗。该模型将用于评估短期和长期临床结果和医疗保健 与美国艾滋病病毒筛查和预防相关的费用，重点放在关键的亚人群上， 这项工作将为未来对艾滋病毒传播的分析奠定基础 暴露前预防和其他新出现的筛查、治疗和预防方式。这位导师 研究将伴随着模型开发、基于试验的模型的推导的相关培训 与政策相关的分析的投入和绩效。这项研究和职业发展培训提供 受试者有一条作为临床研究人员的独立职业道路，专注于使用建模 优化对受艾滋病毒影响的青少年和年轻人的护理的方法。

Project Summary/Abstract New HIV infections among youth ages 13-24 comprise 22% of all new HIV infections in the US. More than 60,000 adolescents and young adults (AYA) are already living with HIV in the US, and new infections contribute substantially to HIV transmission. The HIV epidemic among US AYA demands new approaches to HIV diagnosis and prevention, with consideration of the challenges of health care delivery and research among AYA living with and at risk of acquiring HIV. Computer simulation health-policy models can add substantial value to clinical trials and observational studies by projecting outcomes beyond the time horizon of clinical studies. This is particularly important for AYA, in whom the effects of HIV infection and treatment may not manifest for many years. This mentored clinical scientist research career development award will allow the recipient, an infectious diseases physician at Massachusetts General Hospital, to develop a research career using modeling methods and cost-effectiveness analysis to evaluate current critical questions in HIV prevention and screening in US AYA. Reducing incident HIV infections, improving HIV screening, optimizing HIV pre-exposure prophylaxis services, and assessing HIV pre-exposure prophylaxis effectiveness are high- priority areas for the NIH Office of AIDS Research (2018 Goals) and NICHD (2017 New Research Priorities). Collaborating with national studies of AYA affected by HIV, this project will develop a new, comprehensive health policy model of HIV disease prevention, diagnosis and treatment in AYA. The model will reflect age- and developmentally-specific AYA patterns of care-seeking behaviors, including engagment in care and adherence to medications. The model will be used to evaluate the short- and long-term clinical outcomes and healthcare costs associated with the screening and prevention of HIV in US AYA, focusing on a key sub-population, young men who have sex with men.This work will build a foundation for future analyses of the delivery of HIV pre-exposure prophylaxis and other emerging screening, treatment and prevention modalities. This mentored research will be accompanied by relevant training in model development, derivation of trial-based model inputs, and performance of policy-relevant analyses. This research and career development training provide the recipient with a pathway to an independent career as a clinical investigator, focused on using modeling methodology to optimize care for adolescents and young adults affected by HIV.