Impact of Mass Incarceration on HIV Acquisition for the Female Partner: An Agent-based Modeling Study of Philadelphia

项目总结 大规模监禁被认为是非洲异性恋者感染艾滋病毒的主要原因 美国女性。监禁会增加对艾滋病毒危险行为(包括同时发生性行为)的参与 伙伴关系、交易性行为和无公寓性行为)对被监禁者和他们的性行为 与普通囚犯相比，伴侣和囚犯感染艾滋病毒的可能性大约是五倍 人口。然而，目前尚不清楚大规模监禁如何影响艾滋病毒的传播和流行。 人口层面。拟议研究的目标是：1)估计艾滋病毒传播的比例 非裔美国女性中发生的可归因于男性性伴侣被监禁的事件 以费城为例；以及2)确定作为预防的治疗(TasP)和预治疗的有效性。 有监禁史的异性伴侣的暴露预防(PrEP)处方策略 根据选定的假设(即艾滋病毒病毒载量、伴侣人数)预防传播可归因于 监禁。 使用一种被称为基于代理的建模的新的复杂系统方法，基于种群的模型将 在代表非洲人的动态性接触网络中模拟艾滋病毒逐月传播 2005-2015年间，生活在费城的美国异性恋男性和女性是艾滋病毒高危人群。在……里面 为了估计可归因于监禁的艾滋病毒传播事件的比例，以下将是 计算：1)艾滋病毒事件、流行和死亡病例的数量；2)所有 妇女和有被监禁的男性伴侣的人；以及3)艾滋病毒发病率的增加， 由于监禁率每增加一个单位而导致的流行率和死亡率。的有效性。 每次流行期间的假想预防情景(即为所有血清不一致夫妇开PrEP处方) 阶段将通过在预先指定的间隔(例如，2，5， 和10年的时间范围)。该模型将基于费城收集的监控数据 公共卫生署，以及与艾滋病毒风险行为有关的经验文献 监禁史。将进行广泛的模型校准和验证程序以进行测试 坚固耐用，确保良好的适配性。 这项研究将首次估计非裔美国人中艾滋病毒传播事件的比例 可归因于大规模监禁的妇女，并确定最大限度减少艾滋病毒传播的战略 由于在社区一级被监禁。该项目的成果为有针对性的预防铺平了道路 确定感染艾滋病毒风险最高的妇女，以及哪些干预策略在以下方面最有效 在美国城市环境中降低总体艾滋病毒发病率。

PROJECT SUMMARY Mass incarceration has been hypothesized to be a major driver of HIV acquisition for heterosexual, African American women. Incarceration can increase engagement in HIV risk behaviors (including concurrent sexual partnerships, transactional sex, and condomless sex) for both the incarcerated person and their sexual partners and inmates are approximately five times as likely to be HIV-infected compared to the general population. However, it is not known how mass incarceration impacts HIV transmission and prevalence at the population-level. The objectives of the proposed study are: 1) to estimate the proportion of HIV transmission events among African American women attributable to a male sexual partner’s incarceration using the city of Philadelphia as a case study; and 2) to determine the effectiveness of treatment as prevention (TasP) and pre- exposure prophylaxis (PrEP) prescription strategies for heterosexual couples with a history of incarceration under selected assumptions (i.e. HIV viral load, number of partners) in preventing transmission attributable to incarceration. Using a novel complex systems approach known as agent-based modeling, a population-based model will simulate HIV transmission month-to-month in a dynamic, sexual-contact network representing African American heterosexual men and women at high-risk of HIV living in the city of Philadelphia from 2005-2015. In order to estimate the proportion of HIV transmission events attributable to incarceration, the following will be calculated: 1) the number of HIV incident, prevalent, and mortality cases; 2) HIV incidence rates among all women and those with an incarcerated male partner; and 3) the percentage increase in HIV incidence, prevalence, and mortality attributable to a one unit increase in the rate of incarceration. The effectiveness of hypothetical prevention scenarios (i.e., PrEP prescription for all serodiscordant couples) during each epidemic phase will be estimated by the fraction of new HIV infections averted over pre-specified intervals (e.g., 2, 5, and 10-year time horizons). The model will be based on surveillance data collected by the Philadelphia Department of Public Health as well as empirical literature regarding HIV risk behaviors associated with a history of incarceration. Extensive model calibration and validation procedures will be conducted to test robustness and ensure goodness of fit. This study will be the first to estimate the proportion of HIV transmission events among African American women attributable to mass incarceration and identify strategies that maximize reductions in HIV transmission due to incarceration at the community level. The results of this project pave the way for targeted prevention by identifying women at highest risk of HIV acquisition and what intervention strategies are most effective in decreasing overall HIV incidence in an urban, U.S. setting.