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

大规模监禁对女性伴侣感染艾滋病毒的影响：费城基于主体的建模研究

• 批准号: 9812762
• 负责人: Joella W. Adams
• 金额: $ 3.88万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-06-01 至 2020-02-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9812762
• 关键词: Adherence; Adverse effects; Affect; African American; Age; American; Americas; Anti-Retroviral Agents; Calibration; Case Study; Cities; Collaborations; Color; Communities; Complex; Couples; Data; Education; Effectiveness; Ensure; Epidemic; Event; Female; General Population; Goals; HIV; HIV Infections; HIV risk; Health; Heterosexuals; High Risk Woman; Imprisonment; Incidence; Individual; Intervention; Investigation; Jail; Life; Literature; Low income; Methodology; Modeling; Persons; Phase; Philadelphia; Population; Prevalence; Prevention; Prevention strategy; Prisons; Probability; Procedures; Public Health; Recording of previous events; Reporting; Research; Risk; Risk Behaviors; Risk Factors; Sexual Partners; Specific qualifier value; Study models; System; Techniques; Testing; Time; Treatment Effectiveness; United States; Unsafe Sex; Validation; Viral; Viral Load result; Woman; Work; attributable mortality; base; evidence base; high risk; high school; i(19); improved; male; men; mortality; novel; novel strategies; population based; pre-exposure prophylaxis; prevent; relative effectiveness; sex; sexual HIV transmission; sexual risk behavior; surveillance data; tool; transmission process; treatment services; urban setting

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.

项目概要 据推测，大规模监禁是异性恋、非洲人感染艾滋病毒的主要驱动因素。 美国妇女。监禁可以增加艾滋病毒危险行为的参与度（包括同时发生的性行为） 伴侣关系、交易性行为和无套性行为）对于被监禁者及其性行为 与一般人相比，伴侣和囚犯感染艾滋病毒的可能性大约是普通人的五倍 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率。 人口层面。拟议研究的目标是：1）估计艾滋病毒传播的比例 非洲裔美国妇女中因男性性伴侣被监禁而发生的事件 费城作为案例研究； 2) 确定治疗作为预防 (TasP) 和预防的有效性 有监禁史的异性夫妇的暴露预防 (PrEP) 处方策略 根据选定的假设（即艾滋病毒病毒载量、伴侣数量）来预防传播 监禁。 使用一种新颖的复杂系统方法（称为基于代理的建模），基于群体的模型将 在代表非洲的动态性接触网络中模拟艾滋病毒的逐月传播 2005 年至 2015 年居住在费城的美国异性恋男性和女性是艾滋病毒高危人群。在 为了估计可归因于监禁的艾滋病毒传播事件的比例，将进行以下计算 计算： 1) HIV 感染病例数、流行病例数和死亡病例数； 2) 所有人的艾滋病毒发病率 妇女和有男性伴侣被监禁的人； 3) HIV 发病率增加的百分比， 监禁率每增加一个单位所导致的患病率和死亡率。的有效性 每次流行期间的假设预防场景（即为所有血清不一致夫妇提供 PrEP 处方） 阶段将根据在预先指定的时间间隔（例如 2、5、 和 10 年的时间范围）。该模型将基于费城收集的监测数据 公共卫生部以及有关与艾滋病相关的艾滋病毒危险行为的实证文献 监禁历史。将进行广泛的模型校准和验证程序来测试 稳健性并确保拟合优度。 这项研究将首次估计非洲裔美国人中艾滋病毒传播事件的比例 大规模监禁造成的妇女问题，并确定最大限度减少艾滋病毒传播的战略 由于社区一级的监禁。该项目的结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女性以及哪些干预策略最有效 降低美国城市环境中艾滋病毒的总体发病率。