The impact of social determinants, conditional cash transfers and primary health care on HIV/AIDS: an integrated retrospective and forecasting approach based on a cohort of 100 million Brazilians

提案标题：社会决定因素、有条件现金转移和初级卫生保健对 艾滋病毒/艾滋病：一种基于1亿巴西人队列的综合回顾和预测方法 项目摘要 在控制艾滋病毒/艾滋病流行的许多方面取得了相当大的进展。但 在扩大成功的国家项目方面，挑战依然存在。这项研究将有助于 关于大规模举措的影响的知识，这些举措既要解决艾滋病的社会和医学决定因素，又要解决 将来自巴西国家艾滋病毒/艾滋病登记册的数据与其他大型数据库相结合 包括“1亿巴西人群体”：一个由超过1亿18岁以上的人组成的虚拟群体 通过连接全国大型社会经济和卫生数据集获得的年数。这将是第一次 研究在非实验条件下，随着时间的推移跟踪这么多的个体 了解社会决定因素、有条件现金转移和初级卫生保健如何影响艾滋病毒/艾滋病 发病率、住院率和死亡率；以及在个人一级接受社会保护如何影响 艾滋病毒/艾滋病结果(抗逆转录病毒治疗的依从性和死亡率)。得益于史无前例的 数据集和提出的方法，我们将评估两种干预措施的影响异质性 大范围的不同亚群，以及可能的协同效应。使用纵向方面 我们将深入探索和评估预期和意想不到的动态、滞后和长期的- 生活条件变化以及有条件现金转移和社区风险敞口的长期影响- 以初级卫生保健为基础。然后，我们将扩大队列，并整合回顾中的估计 随着对几个备选政策情景的预测的发展而进行的评估。使用 创新的联合微观模拟和基于代理的模型，我们将能够预测 目前巴西的经济危机，总体上和对几个群体来说，都是对艾滋病毒/艾滋病流行病的影响。我们 将预测和比较一系列替代政策情景的影响，例如 维持目前对有条件现金转移和初级保健的支助水平，减少 财政紧缩措施的覆盖范围和收益，或在不同亚群和 不同的动力。我们将校准和选择能够最大限度地 即使在经济危机期间，也能从艾滋病毒/艾滋病疫情中获益。实证结果和 该项目中产生的创新数学模型将是对 在中低收入国家环境中了解和控制艾滋病毒/艾滋病，以及 美国的弱势群体。

Proposal Title: The impact of social determinants, conditional cash transfers and primary health care on HIV/AIDS: an integrated retrospective and forecasting approach based on a cohort of 100 million Brazilians Project Summary Considerable progress has been made in controlling many aspects of the HIV/AIDS epidemic. But challenges remain in terms of scaling up successful national programs. This study will contribute to knowledge on the impact of large-scale initiatives addressing both the social and medical determinants of HIV/AIDS by combining data from Brazil’s national HIV/AIDS registry with other largescale databases including the “100 Million Brazilian Cohort”: a virtual cohort of more than 100 million individuals over 18 years obtained by the linkage of large countrywide socioeconomic and health datasets. It will be the first study to follow such a large number of individuals over time and in non-experimental conditions to understand how social determinants, conditional cash transfers and primary health care affect HIV/AIDS incidence, hospitalization and mortality; and how receipt of social protections at the individual level affects HIV/AIDS outcomes (ART adherence and mortality). Thanks to the unprecedented dimension of the dataset and the methods proposed, we will assess impact heterogeneities of the two interventions in a large range of different subpopulations, as well as possible synergistic effects. Using the longitudinal aspect of the cohort we will explore and assess in depth expected and unexpected dynamics, lagged and long- term effects of changes in living conditions and in exposures to conditional cash transfers and community- based primary health care. We will then expand the cohort and integrate estimates from the retrospective evaluations with the development of forecasting for several alternative policy scenarios. Using an innovative joined microsimulation and agent-based model we will be able to forecast the effects of the current Brazilian economic crisis, overall and for several subpopulations, on the HIV/AIDS epidemic. We will forecast and compare the impact of a wide range of alternative policy scenarios, such as the maintenance of current levels of support of conditional cash transfer and primary care, reductions of coverage and benefits due to fiscal austerity measures, or expansion in different subpopulation and with different dynamics. We will calibrate and select the combinations of policy response able to maximize the benefits on the HIV/AIDS epidemic, even during an economic crisis. The empirical results and the innovative mathematical models produced in this project will represent an essential contribution to the understanding and control of HIV/AIDS in lower and middle income country settings, as well as for vulnerable populations in the United States.