Adolescent-tailored HIV treatment and prevention strategies in South Africa: projecting clinical benefits and value

项目摘要 在全球范围内，与艾滋病毒相关的死亡人数比2004年的峰值下降了60%。青少年和青壮年 然而，10岁至24岁的(Aya)是唯一一个在艾滋病毒相关方面没有改善的年龄段 从那时起死亡人数。青春期是一个独特的发展时期，在这个时期，冒险和冲动 决策是规范的行为。耻辱、披露担忧和药物毒性影响艾滋病毒 健康行为的时候，阿雅也可能经历他们的第一次性关系。艾滋病病毒的差异 按年龄分列的健康结果部分是由于诊断较晚，以及在获得治疗和治疗方面的困难。 需要每天坚持的预防模式。这个问题在南非尤为严重，它已经 这是世界上最大的艾滋病毒流行，那里三分之一的新感染病例发生在阿亚人之间。近期 长效HIV预防和治疗配方的进展，避免了每日服用药片的需要 重大承诺，特别是对阿亚来说。NICHD K08 HD094638(2018-2023)对Neilan博士的支持 以及青少年药物艾滋病毒/艾滋病干预试验网络U24HD089880(2017-2022)， 我们制定了预防艾滋病并发症的成本效益-青少年和青壮年(CEPAC- Aya)微观仿真模型。我们已经进行了12项基于模型的临床和成本-效果分析 解决美国艾滋病病毒预防、诊断和治疗中的关键问题。在一个新的美国- 南非合作，我们现在建议调整和扩展这一模拟模型的结构，并 收集必要的数据输入，然后使用模型来确定最有效和最具成本效益的 治疗和预防南非阿亚族艾滋病毒的方法和监测战略。我们 有三个具体目标： 目标1.在CEPAC-AYA模型内开发新的结构，并获得数据，以便能够对 南非阿亚的长效ART和PrEP方案。 目的2.评估新的以AYA为重点的治疗的临床影响、成本和成本效益 减少南非阿亚族机会性感染和死亡率的干预措施。 目的3.评估新的以Aya为重点的预防措施的临床影响、成本和成本效益 减少南非阿亚地区艾滋病毒发病率的干预措施。 该提案的目标是评估针对具体情况、针对青少年量身定做的护理策略，并确定 以最佳方式利用有限的资源，改善南非受艾滋病毒影响的Aya人的健康状况。作为新的 治疗和输送系统的出现，该模型将准备好告知如何最好地部署这些 为这一弱势群体提供资源。

PROJECT ABSTRACT Globally, HIV-related deaths have decreased 60% from their peak in 2004. Adolescents and young adults (AYA) ages 10 to 24, however, comprise the only age group that has not seen improvements in HIV-related mortality since then. Adolescence is a distinct developmental period, in which risk-taking and impulsive decision-making are normative behaviors. Stigma, disclosure concerns, and medication toxicity impact HIV health behaviors at a time when AYA may also experience their first sexual relationships. Differences in HIV health outcomes by age are partly due to late diagnosis, as well as to challenges in accessing treatment and prevention modalities requiring daily adherence. This problem is particularly acute in South Africa, which has the largest HIV epidemic in the world, with one in three new infections there occurring among AYA. Recent advances in long-acting HIV prevention and treatment formulations that avert the need to take a daily pill hold major promise, particularly for AYA. With support to Dr. Neilan from an NICHD K08 HD094638 (2018-2023) as well as from the Adolescent Medicine for HIV/AIDS Interventions Trials Network U24HD089880 (2017-2022), we developed the Cost-effectiveness of Preventing AIDS Complications-Adolescent and Young Adult (CEPAC- AYA) microsimulation model. We have conducted 12 model-based clinical and cost-effectiveness analyses addressing key questions in AYA HIV prevention, diagnosis, and treatment in the United States. In a new US- South Africa collaboration, we now propose to adapt and expand the structure of this simulation model and assemble necessary data inputs, and then to use the model to identify the most effective and cost-effective approaches and monitoring strategies for the treatment and prevention of HIV among AYA in South Africa. We have three specific aims: Aim 1. Develop new structure within the CEPAC-AYA model and derive data to permit modeling of long-acting ART and PrEP regimens for AYA in South Africa. Aim 2. Evaluate the clinical impact, cost, and cost-effectiveness of new AYA-focused treatment interventions to decrease opportunistic infections and mortality among AYA in South Africa. Aim 3. Assess the clinical impact, cost, and cost-effectiveness of new AYA-focused prevention interventions to reduce HIV incidence among AYA in South Africa. The goal of this proposal is to evaluate context-specific, adolescent-tailored care strategies and to identify the best use of limited resources to improve health outcomes for AYA affected by HIV in South Africa. As new treatments and delivery systems emerge, the model will be poised to inform how to best deploy these resources for this vulnerable population.