Projecting the age shift in HIV prevalence in sub-Saharan Africa: a necessary epidemiologic step to prepare for the silver tsunami

预测撒哈拉以南非洲艾滋病毒流行率的年龄变化：应对银色海啸的必要流行病学步骤

• 批准号: 10762075
• 负责人: Kristen A. Stafford
• 金额: $ 19.53万
• 依托单位: UNIVERSITY OF MARYLAND BALTIMORE
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-23 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10762075
• 关键词: 1 year old; Acceleration; Achievement; Acquired Immunodeficiency Syndrome; Address; Africa South of the Sahara; African; Age; Age Distribution; Age Years; Aging; Botswana; Caring; Categories; Characteristics; Complex; Country; Data; Diabetes Mellitus; Diagnosis; Disease; Disease Management; Emergency Situation; Epidemic; Epidemiology; Foundations; Goals; HIV; HIV diagnosis; Health; Health system; Healthcare; Healthcare Systems; Hypertension; Incidence; Institution; Kidney Diseases; Knowledge; Letters; Life Expectancy; Malignant neoplasm of cervix uteri; Modeling; Network-based; Outcome; Participant; Persons; Population; Prevalence; Probability; Research; Research Personnel; Resources; Risk; Sexual Partners; Silver; Survey Methodology; Surveys; Testing; Time; Training; Tsunami; Update; Viral; Work; Zambia; age group; age stratification; antiretroviral therapy; burden of illness; cohort; disorder risk; epidemic response; epidemiological model; experience; mortality; population based; predictive modeling; programs; response; risk prediction; sex; transmission process

PROJECT SUMMARY Epidemiologic models have predicted that by 2040, 27% of the population living with HIV in sub-Saharan Africa (SSA) will be 50 years of age or older; however, these models appear to underestimate both the timing and magnitude of the age shift. As of 2022, 21% of all people on antiretroviral therapy (ART) in countries supported by the President's Emergency Plan for AIDS Relief are 50 years of age and older. As the HIV epidemic in SSA comes under control—with more people living with HIV (PLWH) diagnosed, placed on ART, and achieving viral suppression—updated models are needed to more accurately predict and plan for coming demands on the HIV-related healthcare system. The burden of HIV-associated noncommunicable diseases (NCD) is well documented, and risk rises markedly with age. With increases in life expectancy among PLWH, healthcare resource limitations, increased focus on integrating NCD management into HIV platforms, and the imperative to achieve and sustain HIV control in all subpopulations, models that accurately capture and predict the age distribution and NCD burden of PLWH are critical to address knowledge gaps and support precision program implementation. We posit that countries in SSA with high HIV burden will experience the shift in the age distribution to greater than 50% of PLWH over the age of 50 at least a decade sooner than predicted by more commonly used models. Botswana and Zambia are two settings with different epidemic characteristics, providing a unique opportunity to develop and test a new demographic prediction model for more accurate prediction of this “silver tsunami” in PLWH and NCD burden. The goal of this study is to use repeated nationally representative data from Botswana and Zambia to develop a cohort model with age-stratified transmission risk that predicts the age distribution and NCD burden among PLWH through 2050. The proposed Epidemiologic Predictions to Inform Programs for Long-term Aging Needs among people living with HIV (EPI-PLAN HIV) project will generate a framework for accurate prediction of both the age shift and NCD risk in aging populations of PLWH through the following aims 1) Characterize sexual networks in Botswana and Zambia using repeated HIV population-based survey data, 2) Build a cohort model with age- stratified HIV transmission risk to predict the age distribution among PLWH over time, and 3) Predict the burden of NCD among PLWH in Botswana and Zambia over time. The outcomes of this project will be used to accelerate the health system's response and serve as the foundation for future research into the growing burden of NCD in PLWH in SSA.

项目总结 流行病学模型预测，到2040年，撒哈拉以南非洲地区27%的艾滋病毒携带者 (SSA)将达到50岁或更大；然而，这些模型似乎低估了时间和 年龄变化的幅度。截至2022年，在所有接受抗逆转录病毒治疗(ART)的国家中，21%的人支持 根据总统的艾滋病紧急救援计划，年龄在50岁及以上者。随着艾滋病在SSA的流行 得到控制-随着更多的艾滋病毒携带者(PLWH)被确诊，接受抗逆转录病毒治疗，并实现病毒感染 抑制-需要更新的模型来更准确地预测和规划未来的需求 与艾滋病毒相关的医疗体系。 艾滋病毒相关的非传染性疾病(NCD)的负担是有据可查的，风险显著上升。 随着年龄的增长。随着PLWH预期寿命的增加，医疗资源的限制，对 将非传染性疾病管理纳入艾滋病毒平台，以及实现和维持所有艾滋病毒控制的必要性 准确捕捉和预测PLWH的年龄分布和非传染性疾病负担的亚群模型有 对于解决知识差距和支持精确计划的实施至关重要。 我们假设，艾滋病毒负担较高的SSA国家将经历年龄分布向更大 超过50%的50岁以上的PLWH比更常用的预测至少提前十年 模特们。博茨瓦纳和赞比亚是两个具有不同疫情特征的背景，提供了独特的 有机会开发和测试新的人口预测模型，以便更准确地预测这一“白银” 公共卫生部门和非传染性疾病负担中的“海啸”。本研究的目标是使用重复的具有全国代表性的 来自博茨瓦纳和赞比亚的数据，以开发具有年龄分层传播风险的队列模型 预测到2050年长春市妇幼保健员的年龄分布和非传染性疾病负担。 建议的流行病学预测，为生活在人群中的长期老龄化需求提供信息 与艾滋病毒(计划免疫规划艾滋病毒)项目将产生一个框架，以准确预测年龄变化和 PLWH老龄化人群中的非传染性疾病风险通过以下目标：1)性行为网络特征 博茨瓦纳和赞比亚使用重复的基于艾滋病毒人口的调查数据，2)建立了年龄-队列模型 分层HIV传播风险以预测PLWH随时间的年龄分布，以及3)预测 随着时间的推移，博茨瓦纳和赞比亚公共卫生部门的非传染性疾病负担。该项目的成果将用于 加快卫生系统的反应，为未来研究不断增长的 SSA中非传染性疾病在PLWH中的负担。