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: 10132984
• 负责人: Davide Rasella
• 金额: $ 42.38万
• 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/10132984
• 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：社会决定者，有条件现金转移和初级卫生保健对 艾滋病毒/艾滋病：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方面取得了长足的进步。但 在扩大成功的国家计划方面，挑战仍然存在。这项研究将有助于 了解大规模计划的影响，以解决的社会和医疗决定者 艾滋病毒/艾滋病通过将巴西国家艾滋病毒/艾滋病注册中心的数据与其他大规模数据库相结合 包括“ 1亿巴西队列”：一个超过18岁以上的人的虚拟队列 通过大型全国社会经济和健康数据集的联系获得的年。这将是第一个 随着时间的推移和非实验条件的研究 了解社会决定者，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，住院和死亡率；以及个人层面上社会保护的接收如何影响 艾滋病毒/艾滋病结果（艺术依从性和死亡率）。谢谢你前所未有的维度 数据集和提出的方法，我们将评估两种干预措施的异质性 大量不同的亚群以及可能的协同作用。使用纵向方面 我们将在预期和意外动态的深度探索和评估该队列中，滞后和长期 生活条件变化以及对有条件现金转移和社区的暴露的期限影响 - 基于初级卫生保健。然后，我们将扩展队列并整合回顾性的估计值 对几种替代政策情景的预测开发的评估。使用一个 创新的加入微仿真和基于代理的模型我们将能够预测 当前的巴西经济危机，总体而言，对于艾滋病毒/艾滋病流行病而言，总体上和几个亚群。我们 将预测并比较广泛的替代政策情景的影响，例如 维持当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种群的扩展以及与 不同的动态。我们将校准并选择策略响应的组合可以最大化 即使在经济危机期间，艾滋病毒/艾滋病流行的益处也是如此。经验结果和 该项目中产生的创新数学模型将代表对 了解和控制中低收入国家环境中的艾滋病毒/艾滋病以及 美国脆弱人群。