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

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/艾滋病的影响：基于一亿巴西人队列的综合回顾和预测方法

• 批准号: 10013594
• 负责人: Davide Rasella
• 金额: $ 45.4万
• 依托单位: FEDERAL UNIVERSITY OF BAHIA
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-04-01 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10013594
• 关键词: AIDS/HIV problem; Address; Adherence; Adult; Affect; Brazil; Communities; Country; Data; Data Set; Databases; Development; Dimensions; Disease; Economics; Epidemic; Evaluation; Exposure to; Family health status; Fees; Future; HIV; Health; Health Promotion; Healthcare; Heterogeneity; Hospitalization; Incidence; Individual; Infant; Injecting drug user; Intervention; Knowledge; Link; Long-Term Effects; Maintenance; Measures; Medical; Medical Care Team; Methods; Modeling; Municipalities; Outcome; Personal Satisfaction; Physicians; Policies; Population; Prevalence; Prevention; Primary Health Care; Qualifying; Randomized Controlled Trials; Registries; Social Protection; Testing; Time; United States; Vulnerable Populations; Work; antiretroviral therapy; base; beneficiary; burden of illness; cohort; experience; health data; improved; innovation; large datasets; longitudinal dataset; low and middle-income countries; mathematical model; meetings; men who have sex with men; mortality; multidisciplinary; programs; response; scale up; sex; social; social determinants; social interventions; socioeconomics; transmission process; treatment adherence; virtual

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.

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 HIV/艾滋病：基于一亿巴西人队列的综合回顾和预测方法 项目概要 在控制艾滋病毒/艾滋病流行的许多方面已经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 关于解决社会和医疗决定因素的大规模举措的影响的知识 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来研究艾滋病毒/艾滋病 其中包括“1 亿巴西队列”：一个由超过 1 亿 18 岁以上个体组成的虚拟队列 通过连接全国范围内的大型社会经济和健康数据集获得的年数。这将是第一个 研究在一段时间内和非实验条件下跟踪如此大量的个体 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；以及个人层面社会保护的获得如何影响 HIV/艾滋病结果（ART 依从性和死亡率）。得益于前所未有的规模 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。使用纵向方面 我们将深入探索和评估预期和意外的动态、滞后的和长期的动态 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性的估计 评估并制定对几种替代政策情景的预测。使用 创新的微观模拟和基于代理的模型相结合，我们将能够预测 当前的巴西经济危机，无论是总体上还是针对某些亚人群，都与艾滋病毒/艾滋病的流行有关。我们 将预测并比较各种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持水平，减少 由于财政紧缩措施或不同亚人口的扩张以及 不同的动态。我们将校准和选择能够最大限度地提高政策反应的组合 即使在经济危机期间，也能从艾滋病毒/艾滋病流行中获益。实证结果和 该项目产生的创新数学模型将对 中低收入国家对艾滋病毒/艾滋病的了解和控制，以及 美国的弱势群体。