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、有条件现金转移支付和初级卫生保健对 艾滋病毒/艾滋病：基于1亿巴西人群体的综合回顾和预测方法 项目摘要 在控制艾滋病毒/艾滋病流行病的许多方面取得了相当大的进展。但 在扩大成功的国家方案方面仍然存在挑战。这项研究将有助于 了解大规模举措的影响，这些举措同时处理社会和医疗决定因素， 将巴西国家艾滋病毒/艾滋病登记处的数据与其他大型数据库相结合， 其中包括“一亿巴西群体”：一个由超过一亿18岁以上的人组成的虚拟群体。 通过全国范围的大型社会经济和卫生数据集的链接获得的年份。这将是第一 在非实验条件下，随着时间的推移跟踪如此大量的个体， 了解社会决定因素、有条件的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;以及在个人一级获得社会保护如何影响 艾滋病毒/艾滋病结果（抗逆转录病毒治疗依从性和死亡率）。由于前所未有的规模， 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。从纵向看 我们将深入探讨和评估预期和意外的动态，滞后和长期- 生活条件和有条件现金转移支付风险变化的长期影响以及社区- 基础卫生保健。然后，我们将扩展队列并整合回顾中的估计值 评价工作，并对若干备选政策设想进行预测。使用 创新加入微观模拟和基于代理的模型，我们将能够预测的影响， 当前巴西经济危机对艾滋病毒/艾滋病流行病的总体影响和几个亚群的影响。我们 将预测和比较各种替代政策情景的影响，例如 维持现有的有条件现金转移和初级保健支助水平， 由于财政紧缩措施，或在不同的亚人口中扩大覆盖面和福利， 不同的动力。我们将调整和选择能够最大限度地发挥作用的政策应对组合 艾滋病毒/艾滋病流行病的好处，即使在经济危机期间。实证结果和 在这个项目中产生的创新数学模型将代表一个重要贡献， 艾滋病毒/艾滋病的认识和控制，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.