Transportability of Causal Effects to Inform HIV Pre-exposure Prophylaxis Implementation

项目摘要 这项提案的长期目标是应用因果推理方法， 实施预防艾滋病毒的暴露前预防（PrEP）。PrEP是一种经过验证的 生物医学干预有可能大幅减少全球艾滋病毒感染人数， 但对PrEP的坚持不足是其有效性的最大障碍。广泛实施 PrEP需要实现PrEP的全部公共卫生潜力，以及最新的战略计划和研究 NIH、PEPFAR、NIMH和艾滋病研究办公室的优先事项都反映了在以下方面开展更多工作的迫切需要： 与艾滋病毒预防有关的实施科学。 没有一个单一的艾滋病毒预防计划是适合所有情况的，在广泛推广PrEP之前，政策- 制造商需要评估PrEP应该如何融入他们自己的艾滋病毒预防计划。这将需要 估计PrEP在每种情况下的预期公共卫生影响，并确定优先人群 有针对性的支持。可运输性为当前这些挑战提供了及时的解决方案 面对PrEP实施领域。 可移植性是一种新的数学框架，用于预测预期的现实世界 干预措施的有效性。该提案的目的是利用可运输性， 通过估计PrEP的实际效果和确定优先事项来实施PrEP 人口的支持。使用来自iPrEx、iPrEx OLE和PrEP DemoProjects的数据， 1将说明如何可移植性可以应用于估计随机干预的有效性 目标2将阐明哪些特征和人群应 优先考虑遵守支持。 拟议的研究将为PrEP的实施提供有价值和及时的见解，并将作为 用于估计PrEP在其他目标人群中的真实有效性的模型。跨学科 培训环境、专家指导和使用尖端方法将为申请人提供 有机会为她的职业生涯发展无与伦比的主题，技术和方法专业知识， 未来的艾滋病预防流行病学独立研究员。

Project Summary The long-term goal of this proposal is to apply causal inference methods to inform implementation of pre-exposure prophylaxis for HIV prevention (PrEP). PrEP is a proven biomedical intervention that has the potential to dramatically reduce the number of HIV infections globally, but insufficient adherence to PrEP is the biggest barrier to its effectiveness. Widespread implementation of PrEP is required to realize PrEP's full public health potential, and the most recent strategic plans and research priorities of NIH, PEPFAR, NIMH, and the Office of AIDS research all reflect the urgent need for more work in implementation science as it relates to HIV prevention. No single HIV prevention program is ideal for all contexts, and before PrEP is rolled out widely, policy- makers need to assess how PrEP should fit into their own HIV prevention programs. This will require estimating the anticipated public health impact of PrEP in each context, and identifying priority populations for targeted adherence support. Transportability provides a timely solution to these challenges currently facing the PrEP implementation field. Transportability is a novel mathematical framework for predicting the anticipated real-world effectiveness of interventions. The objective of this proposal is to use transportability to inform PrEP implementation by estimating PrEP's real-world effectiveness and identifying priority populations for adherence support. Using data from the iPrEx, iPrEx OLE, and PrEP DemoProjects, Aim 1 will illustrate how transportability can be applied to estimate the effectiveness of a randomized intervention in a distinct target population, and Aim 2 will clarify which characteristics and populations should be prioritized for adherence support. The proposed study will provide valuable and timely insight for PrEP implementation, and will serve as a model for estimating real-world effectiveness of PrEP in other target populations. The interdisciplinary training environment, expert mentorship, and use of cutting edge methods will provide the applicant an opportunity to develop unmatched subject matter, technical, and methodological expertise for her career as a future independent researcher in HIV prevention epidemiology.