Miami Dade County ASsessment of Phylogenetics to Improve Resource Equity: MD ASPIRE

摘要 结束艾滋病毒流行(EHE)倡议大胆旨在将高负担地区的艾滋病毒发病率降低90% 然而，到2030年，在衡量发病率以确定优先人群并知道如何最好地 分配当地资源。到目前为止，基于艾滋病毒分子监测的干预措施尚未与 减少艾滋病毒的发病率。也就是说(除了极少数例外)，公共卫生努力针对的是与 随着艾滋病毒传播的快速增长，聚集性传播并不能减少新的艾滋病毒感染人数 或在提供这些服务的地区或群体中受到病毒压制的人的比例。 没有现有的资源分配模型是由当地分子和艾滋病毒计划数据通知的 确定如何最好地分配与EHE目标相关的资源。“洛杉矶县对 改善资源公平的系统动力学(LAC ASPIRE)“团队将使用i)高级系统动力学 确定传播率最高人群的发病率方法和前瞻性措施 在洛杉矶县(LAC)和二)建立经济模型以优化公共卫生方案资源的分配 以实现EHE和其他利益相关者的目标。ASPIRE团队是调查人员在 几所学术大学和拉丁美洲及加勒比地区艾滋病毒和性传播疾病方案司(艾滋病规划署)。分析将使用编码 以及由LAC dhsp提供的未识别的艾滋病毒监测数据和方案数据。拟议的研究将 确定传播率最高的LAC人群，并将其表示为优先人群。我们将使用 经济建模，以制定战略，优化预防资源的分配，以i)减少艾滋病毒 第二，改善与艾滋病毒相关的健康结果；第三，改善人口之间的公平。我们将与 利益相关者--定义为1)拉丁美洲和加勒比地区卫生和公众服务部人员，2)直接或间接参与管理艾滋病毒的人员 拉丁美洲和加勒比地区的方案，以及3)艾滋病毒携带者和其他主要受影响人群--就 既为区域所接受又最有可能实现的人口和资源优先战略 每个目标都是。 总体研究目标是开发一个过程来指导与分配艾滋病毒计划有关的决策 公共卫生部门通过区域规划和传播数据提供的资源。特定于项目 目标包括：目标1(确定)。确定艾滋病毒预防工作中最优先考虑的人群(这些 数据将为目标2中使用的流行病模型提供信息；目标2(分配)。开发一种用户友好的动态 将预测资源优化分配的替代战略的影响的传输模型 Lac艾滋病毒预防方案(这些数据将预测健康结果和成本效益)；和目标3 (交战)。让关键的利益相关者参与制定流程，以指导项目成果并在 Lac卫生部提供的数据分析，结合了目标1和目标2的方法。

ABSTRACT The Ending the HIV Epidemic (EHE) Initiative boldly aims to reduce HIV incidence in high burden areas by 90% by 2030, yet challenges remain in measuring incidence to identify priority populations and knowing how to best allocate local resources. To date, HIV molecular surveillance-based interventions have not been linked to a reduction in HIV incidence. That is (with rare exception), public health efforts directed to individuals associated with rapidly growing HIV transmission clusters have not been shown to reduce the number of new HIV infections or the proportion of people virally suppressed in the regions or groups where these services were delivered. There are no existing resource allocation models that are informed by local molecular and HIV program data to determine how to best allocate resources relevant to EHE targets. The “Los Angeles County ASsessment of Phylodynamics to Improve Resource Equity (LAC ASPIRE)” team will use i) advanced phylodynamic approaches and prospective measures of incidence to identify populations with the highest transmission rates in Los Angeles County (LAC) and ii) economic modeling to optimize allocation of public health program resources to achieve EHE and other stakeholder targets. The ASPIRE team is a partnership between investigators at several academic universities and the LAC Division of HIV and STD Programs (DHSP). Analyses will use coded and de-identified HIV surveillance data and program data provided by the LAC DHSP. The proposed study will identify LAC populations with the highest transmission rates and denote as priority populations. We will use economic modeling to develop strategies that optimize the allocation of prevention resources to i) reduce HIV incidence, ii) improve HIV-related health outcomes, and iii) improve equity across populations. We will engage stakeholders—defined as 1) LAC DHSP personnel, 2) those directly or indirectly involved in administering HIV Programs in LAC, and 3) persons with HIV (PWH) and other key affected populations—to provide guidance on population and resource prioritization strategies that are both regionally acceptable and most likely to achieve EHE targets. The overall study objective is to develop a process to guide decision-making related to allocation of HIV program resources by public health departments informed by regional program and transmission data. Project specific aims include: Aim 1 (IDENTIFY). Identify populations that are the highest priority for HIV prevention efforts (these data will inform the epidemic model used in Aim 2); Aim 2 (ALLOCATE). Develop a user-friendly dynamic transmission model that will project the impact of alternative strategies for the optimal allocation of resources to LAC HIV prevention programs (these data will project health outcomes and cost-effectiveness); and Aim 3 (ENGAGE). Engage key stakeholders to develop a process to guide project outcomes and build capacity at the LAC Health Department for data analysis that incorporates Aim 1 and 2 methods.