The role of PrEP in Getting to Zero

PrEP 在“零”目标中的作用

• 批准号: 10619134
• 负责人: Daniel Escudero
• 金额: $ 87.95万
• 依托单位: VANDERBILT UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-05-04 至 2027-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10619134
• 关键词: AIDS prevention; Address; Adherence; Algorithms; Area; Awareness; Behavioral; Black Populations; Boston; Calibration; Caring; Centers for Disease Control and Prevention (U.S.); Cities; Clinical; Communities; Complex; Continuity of Patient Care; Country; Couples; Data; Development; Electronic Health Record; Eligibility Determination; Enrollment; Epidemic; Epidemiology; Face; Future; Goals; Guidelines; HIV; HIV Infections; HIV diagnosis; HIV risk; Heterosexuals; Hispanic Populations; Human immunodeficiency virus test; Incidence; Injecting drug user; International; Investments; Location; Measures; Methods; Modality; Modeling; Monitor; Network-based; New York City; Phase; Policies; Policy Maker; Population; Prevention; Prevention Guidelines; Publishing; Randomized; Recording of previous events; Reporting; Research; Risk Behaviors; Role; San Francisco; Testing; United States; United States Dept. of Health and Human Services; Viral; access disparities; antiretroviral therapy; black women; condoms; efficacy trial; epidemiological model; evidence base; high risk; high risk population; innovation; men who have sex with men; men who have sex with men and women; metropolitan; pre-exposure prophylaxis; prevent; programs; rural setting; simulation; success; tool; transgender women; transmission process; uptake; young men who have sex with men

PROJECT SUMMARY/ABSTRACT Progress in HIV prevention in the United States (US) has stalled, according to reports from the Centers for Disease Control and Prevention. Most recently, the Department of Health and Human Services has made Ending the HIV Epidemic (EHE) a national priority, with intermediate goals of a 75% reduction within five years and a 90% reduction in 10 years. Getting to Zero (GTZ) programs rely on the concept of combination HIV prevention, using evidence-based methods that have been tailored to suit local needs. Among each of these programs is an emphasis on pre-exposure prophylaxis (PrEP), which is a versatile tool able to prevent acquisition of HIV infection within diverse HIV-risk communities. Despite the success of PrEP in efficacy trial settings, uptake has been slow in the US and highly variable: coverage among those with indications for PrEP is estimated to range from 5-41% (median 18%), among US states. Agent-based stochastic modeling is highly equipped to investigate complex epidemiologic questions, such as the effects of the PrEP continuum in diverse settings, populations, and as part of combination HIV prevention. The HIV Calibrated Dynamic Model (HIV-CDM), simulates HIV testing, transmission, treatment, and prevention among a wide range of epidemic settings and is able to address the crucial questions facing PrEP implementation in the US. Using the HIV-CDM, we propose to address the following aims: Specific Aim 1: To expand and calibrate the current HIV-CDM to capture the epidemic dynamics, HIV risk behavior, network mixing, and access to HIV prevention modalities within the most prominent GTZ programs and priority settings throughout the US, using empirical data from ongoing and completed studies among MSM, men who have sex with men and women, people who inject drugs, and high-risk heterosexuals. Specific Aim 2: To simulate the PrEP continuum in eight key US cities, including PrEP eligibility within specific populations, access, retention, and adherence. To inform these simulations, and generate estimates for PrEP utilization up to 10 years into the future, we will integrate empirical data for each step of the continuum. This will include a focus on both the development and testing of diverse PrEP eligibility measures, including electronic health record-based algorithms, clinical checklists, and CDC guidelines. Specific Aim 3: To evaluate the potential to reduce HIV incidence by 75% in five years, and 90% in 10 years, through targeted PrEP expansion, within the context of existing combination prevention packages in settings with a history of HIV prevention successes (e.g., Boston and San Francisco), settings that have struggled in their GTZ efforts (Miami, Atlanta), and largely-rural settings (Birmingham) that are priority areas for the EHE initiative. This approach will include network-based analyses that will investigate the most efficient methods of PrEP delivery within heterogenous epidemics.

项目摘要/摘要 根据美国艾滋病预防中心的报告，美国在预防艾滋病毒方面的进展已经停滞不前 疾病控制与预防。最近，卫生与公众服务部做出了 结束艾滋病毒流行(EHE)是国家优先事项，中期目标是在五年内减少75% 并在10年内减少90%。归零(GTZ)计划依赖于组合的概念 艾滋病毒预防，使用基于证据的方法，这些方法是根据当地需要量身定做的。在每个人中 这些计划强调暴露前预防(PrEP)，这是一种能够预防 在不同的艾滋病毒风险社区内获得艾滋病毒感染。尽管PrEP在疗效试验中取得了成功 在美国，接受治疗的速度很慢，而且变数很大：PrEP适应症患者的覆盖率 在美国各州，估计在5%-41%(中位数18%)之间。 基于代理的随机建模非常适合研究复杂的流行病学问题，例如 PrEP连续体在不同环境、人群中的影响，以及作为艾滋病毒联合预防的一部分。 HIV校准动态模型(HIV-CDM)模拟HIV检测、传播、治疗和 在广泛的流行病环境中进行预防，并能够解决PrEP面临的关键问题 在美国实施。利用艾滋病毒-清洁发展机制，我们建议实现以下目标： 具体目标1：扩大和调整目前的艾滋病毒-清洁发展机制，以掌握流行动态、艾滋病毒风险 在最突出的德国技术合作项目中的行为、网络混合和获得艾滋病毒预防模式的机会 和美国各地的优先事项设置，使用正在进行的和已完成的研究中的经验数据 男男性接触者，与男性和女性发生性关系的男性，注射毒品的人，以及高危异性恋者。 具体目标2：模拟美国八个主要城市的PrEP连续体，包括 特定人群、访问、保留和遵从性。为这些模拟提供信息，并生成估计 对于未来长达10年的PrEP利用率，我们将整合每个步骤的经验数据 连续体。这将包括将重点放在制定和测试各种预审计划资格措施上， 包括基于电子健康记录的算法、临床检查表和疾病预防控制中心指南。 具体目标3：评估在5年内将艾滋病毒发病率降低75%，在10年内减少90%的潜力， 通过有针对性的PrEP扩展，在环境中现有的组合预防方案的背景下 有艾滋病毒预防成功的历史(例如波士顿和旧金山)，在 他们的GTZ努力(迈阿密、亚特兰大)和以农村为主的环境(伯明翰)是EHE的优先领域 主动权。这种方法将包括基于网络的分析，这些分析将调查最有效的方法 在异质性流行病中进行PrEP传递的可能性。