PEARL 2.0: The impact of the Ending the HIV Epidemic initiative and risk factor interventions on the projected multimorbidity burden and healthcare costs for people aging with HIV in the United States

项目总结 在接下来的十年里，近100万艾滋病毒(PAH)老年患者在美国使用抗逆转录病毒疗法(ART) 美国将经历几十年的预期寿命。该项目的目标是构建一套 用于进一步预测年龄、多发病和多药(PEAR)计算机模拟模型的模块 为政府和政府的临床计划和政策决策和资源分配提供信息的能力 私营医疗系统正在努力满足未来护理PAH的需求。 结束艾滋病毒流行的努力无疑将重塑黑人/非洲人的年龄分布 美国人(AA)、西班牙人和白人PAH在性行为和艾滋病毒感染风险组中。在各种情况下的预测 这些子组中的EHE目标实现策略的情景需要回答这个问题：如何实现 EHE的努力是否会影响未来20年内老年PAH(需要临床护理)的数量？AS PAH 与未感染艾滋病毒的人相比，经历了更大的多发病负担，而且在PAH中仍然存在差异 亚组、临床方案和政策决策者需要知道：“显著风险因素的减少 在美国减少未来PAH的多发病？“模拟吸烟等显著危险因素的减少 和肥胖，并估计对未来多发性疾病的影响将提供不存在的数据。最后，通过 调查这样一个问题：在接下来的2年里，在美国照顾PAH的未来医疗费用是多少？ 几十年？“临床主任、卫生系统以及州和联邦政策决策者可以为未来做好准备 卫生保健需求和资源分配。 已建立的珍珠建模团队将(A)与约翰霍普金斯大学艾滋病毒流行经济学密切合作 模型(JHEEM)团队构建一个模块来模拟EHE努力的影响，(B)继续其有益的 与北美艾滋病队列研究和设计合作(NA-ACCORD)合作 构建合并症预防模块，以及(C)构建成本计算模块，以实现以下目标 到2040年在美国使用抗逆转录病毒治疗的15个PAH亚组： 目标1：评估EHE目标对预计人数和年龄分布的影响。 目的2：预测减少显著危险因素对未来多发病负担的影响。 目标3：评估干预措施的成本效益，以减少风险因素，并预测艾滋病毒-和非艾滋病毒- 相关的医疗成本。 拟议的目标与2021-25年艾滋病毒和艾滋病毒相关跨国立卫生研究院计划的研究优先事项保持一致 研究并包括艾滋病毒/艾滋病和老龄化的多学科研究(PAR-21-068)优先成果。发现 将在15个PAH亚组内提供关键的艾滋病毒流行病学和卫生服务数据，以指导临床计划 并通知医疗保健资源分配，以最终改善美国PAH的健康状况。

PROJECT SUMMARY Within the next decade, nearly 1 million people aging with HIV (PAH) using antiretroviral therapy (ART) in the United States (US) will experience multi-decade life expectancy. The goal of this project is to build a suite of modules to further the ProjEcting Age, multimoRbidity and poLypharmacy (PEARL) computer simulation model’s capacity to inform clinical program and policy decision-making and resource allocation in governmental and private healthcare systems in efforts meet the future needs of caring for PAH. The Ending the HIV Epidemic (EHE) efforts will undoubtedly re-shape the age distributions of Black/African American (AA), Hispanic, and white PAH within sex-and-HIV acquisition risk groups. Projections under various scenarios of EHE goal attainment strategies within these subgroups are needed to answer the question: “How will EHE efforts impact the number of older PAH (who need clinical care) over the next two decades?” As PAH experience a greater burden of multimorbidity than people without HIV, and disparities persist within PAH subgroups, clinical program and policy decision-makers need to know: “Can reductions in prominent risk factors reduce future multimorbidity in PAH in the US?” Simulating reductions in prominent risk factors, such as smoking and obesity, and estimating the impact on future multimorbidity will provide data where none exist. Finally, by investigating the question “What are the future healthcare costs for caring for PAH in the US over the next 2 decades?” clinical directors, health systems and state and federal policy decision-makers can prepare for future health care needs and allocation of resources. The established PEARL modeling team will (a) collaborate closely with Johns Hopkins HIV Epidemic Economic Model (JHEEM) team to construct a module to simulate the impact of EHE efforts, (b) continue their beneficial partnership with the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) to construct a comorbidities prevention module, and (c) construct a costing module to achieve the following among 15 PAH subgroups using ART in the US through 2040: AIM 1: To assess the impact of EHE goals on the projected number and age distribution. AIM 2: To project the impact of reducing prominent risk factors on future multimorbidity burden. AIM 3: To estimate the cost effectiveness of interventions to reduce risk factors and project HIV- and non-HIV- related healthcare costs. The proposed aims align with the research priorities of the 2021-25 Trans-NIH Plan for HIV and HIV-Related Research and include Multidisciplinary Studies of HIV/AIDS and Aging (PAR-21-068) priority outcomes. Findings will provide key HIV epidemiologic and health services data within 15 PAH subgroups to guide clinical programs and informing healthcare resource allocations to ultimately improve the health of PAH in the US.