Using agent-based modeling to estimate the effectiveness of the Miami Getting to Zero HIV campaign

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Project Summary/Abstract Agent-based modeling has provided epidemiologists with an advanced tool to estimate critical epidemiologic outcomes among large, diverse populations. The proposed research will build on a well-established model platform, the HIV-Calibrated Dynamic Model (HIV-CDM), to construct a model of the HIV epidemic in Miami, which experiences among the highest rates of new HIV infection in the country. In response to the growing HIV epidemic in Miami, local policymakers, clinicians, and researchers have formed a “Getting to Zero” Task Force that seeks to eliminate all new HIV infections in the Miami metropolitan area. The campaign is founded on the principle of combination prevention, which enlists the concurrent use of many evidence-based prevention strategies, such as treatment as prevention, pre-exposure prophylaxis (PrEP), and frequent/targeted HIV testing. Presently it is unknown what effect this campaign will have on incident HIV infections in Miami. This proposal seeks to use agent-based modeling to estimate the long-term impact of the combination prevention program outlined in the Getting to Zero campaign adopted in 2017. Along with estimating specific epidemic outcomes (e.g., HIV incidence, HIV prevalence, time to epidemic elimination), this approach may also assess the relative contribution of each component to the success of the program. Such estimates will be crucial in maximizing the goals of the campaign, as well as assist with the implementation of similar HIV elimination programs. This proposal will: (1) expand the HIV-CDM model, to simulate the demographics and HIV risk behavior of the diverse metropolitan Miami population; (2) estimate the success and limitations of the Getting to Zero campaign using the HIV-CDM model; and (3) perform primary and secondary analyses within subgroups of the Miami population to better understand current research gaps, and those identified in the first two aims. Each component of the research plan will be supported and aligned with specific training components designed to provide the candidate with the necessary professional development and mentorship to execute the research aims, and begin an independent research career. The results obtained from this work may directly impact the assessment of the Miami Getting to Zero campaign and inform all future HIV elimination campaigns in the U.S. and globally. Additionally, the training program will provide exceptional methodological and practical experience leading to an independent and influential scientific career. Supporting this work will be a mentorship team of academic and community leaders in HIV elimination, epidemiology and modeling methodology. This mentorship will build on the methodological and substantive experience I have demonstrated while leading numerous studies on epidemic modeling and HIV epidemiology.