PEARL 2.0: The impact of the Ending the HIV Epidemic initiative and risk factor interventions on the projected multimorbidity burden and healthcare costs for people aging with HIV in the United States

项目摘要 在未来十年内，近100万艾滋病毒（PAH）老年人使用抗逆转录病毒治疗（ART）， 美国（US）将经历数十年的预期寿命。这个项目的目标是建立一套 模块，以进一步突出时代，多学科和多学科（PEARL）计算机模拟模型的 为政府和私人医疗保健的临床决策和资源分配提供信息的能力 这些系统正在努力满足未来治疗PAH的需求。 结束艾滋病毒流行（EHE）的努力无疑将重新塑造黑人/非洲人的年龄分布， 美国人（AA）、西班牙裔和白色PAH在性和HIV获得风险组中。各种预算下的预测数 需要在这些子群体中制定EHE目标实现战略方案，以回答以下问题：“如何 EHE工作是否会在未来二十年内影响老年PAH（需要临床护理）的数量？” 由于PAH比没有HIV的人经历更大的多重感染负担， PAH亚组，必须对许多合并症的共同风险因素进行干预，如吸烟 吸烟和肥胖。有必要回答以下问题： 在美国，许多合并症可降低PAH的未来多发病率，这些干预措施的成本- 有效吗？”在ART开始后的前24个月内戒烟和维持体重可能会减少 未来多死亡的风险与目前的临床和行政决策。最后通过 调查以下问题：“未来美国治疗PAH的医疗保健成本是多少？ 二十年？”临床主任、卫生系统以及州和联邦政策决策者可以做好准备， 成本和选择成本效益高的干预措施。 建立PEARL模型团队将（a）与约翰霍普金斯艾滋病毒流行病学经济学密切合作 模型（JHEEM）团队构建一个模块来模拟EHE工作的影响，（B）继续他们的有益 与北美艾滋病队列研究和设计合作组织（NA-ACCORD）合作， 构建风险因素干预模块，以及（c）构建成本计算模块，以实现以下目标： 到2040年，美国使用ART的15个PAH亚组： 目的1：模拟EHE目标对预计人数和年龄分布的影响。 目的2：预测风险因素干预后多死亡率负担的变化。 目的3：估计干预措施的成本效益，并预测艾滋病毒和非艾滋病毒相关的医疗保健费用。 拟议的目标与2021- 2025年跨NIH艾滋病毒和艾滋病毒相关疾病计划的研究重点保持一致。 研究并纳入艾滋病毒/艾滋病和老龄化多学科研究（PAR-21-068）的优先成果。结果 将提供15个PAH亚组的关键HIV流行病学、临床和卫生服务数据，以指导临床 管理和告知医疗保健资源分配，以最终改善美国PAH的健康状况。

PROJECT SUMMARY Within the next decade, nearly 1 million people aging with HIV (PAH) using antiretroviral therapy (ART) in the United States (US) will experience multi-decade life expectancy. The goal of this project is to build a suite of modules to further the ProjEcting Age, multimoRbidity and poLypharmacy (PEARL) computer simulation model’s capacity to inform clinical decision-making and resource allocation in governmental and private healthcare systems in efforts meet the future needs of caring for PAH. The Ending the HIV Epidemic (EHE) efforts will undoubtedly re-shape the age distributions of Black/African American (AA), Hispanic, and White PAH within sex-and-HIV acquisition risk groups. Projections under various scenarios of EHE goal attainment strategies within these subgroups are needed to answer the question: “How will EHE efforts impact the number of older PAH (who need clinical care) over the next two decades?” As PAH experience a greater burden of multimorbidity than people without HIV, and disparities persist within PAH subgroups, it is essential to intervene upon shared risk factors for numerous comorbidities, such as cigarette smoking and obesity. It is pertinent to answer the questions “Can interventions on shared risk factors for numerous comorbidities reduce future multimorbidity in PAH in the US, and are such interventions cost- effective?” Smoking cessation and weight maintenance in the first 24 months after ART initiation may reduce the risk of future multimorbidity with present-day clinical and administrative decision-making. Finally, by investigating the question “What are the future healthcare costs for caring for PAH in the US over the next 2 decades?” clinical directors, health systems and state and federal policy decision-makers can prepare for costs and select cost effective interventions. The established PEARL modeling team will (a) collaborate closely with Johns Hopkins HIV Epidemic Economic Model (JHEEM) team to construct a module to simulate the impact of EHE efforts, (b) continue their beneficial partnership with the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) to construct a risk factor intervention module, and (c) construct a costing module to achieve the following among 15 PAH subgroups using ART in the US through 2040: AIM 1: To simulate the impact of EHE goals on the projected number and age distribution. AIM 2: To project the change in the multimorbidity burden with risk factor interventions. AIM 3: To estimate the cost effectiveness of interventions and project HIV- and non-HIV-related healthcare costs. The proposed aims align with the research priorities of the 2021-25 Trans-NIH Plan for HIV and HIV-Related Research and include Multidisciplinary Studies of HIV/AIDS and Aging (PAR-21-068) priority outcomes. Findings will provide key HIV epidemiologic, clinical, and health services data within 15 PAH subgroups to guide clinical management and informing healthcare resource allocations to ultimately improve the health of PAH in the US.