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 为临床项目和政策决策以及政府和 私人医疗保健系统正在努力满足未来对PAH的护理需求。 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？”作为PAH 与未感染艾滋病毒的人相比， 亚组、临床项目和政策决策者需要知道：“显著风险因素的减少 减少美国PAH的未来多发病率？”模拟减少突出的风险因素，如吸烟 和肥胖，并估计对未来多发病的影响，将提供数据，其中没有存在。最后通过 调查问题“未来2年美国治疗PAH的未来医疗保健成本是多少？ 几十年？”临床主任、卫生系统以及州和联邦政策决策者可以为未来做好准备。 卫生保健需求和资源分配。 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， 构建并发症预防模块，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：评估EHE目标对预计人数和年龄分布的影响。 目的2：预测减少突出的危险因素对未来多重死亡负担的影响。 目的3：评估干预措施的成本效益，以减少风险因素，并预测艾滋病毒感染者和非艾滋病毒感染者， 相关的医疗费用。 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流行病学和卫生服务数据，以指导临床项目 并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 program and policy 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, clinical program and policy decision-makers need to know: “Can reductions in prominent risk factors reduce future multimorbidity in PAH in the US?” Simulating reductions in prominent risk factors, such as smoking and obesity, and estimating the impact on future multimorbidity will provide data where none exist. 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 future health care needs and allocation of resources. 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 comorbidities prevention 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 assess the impact of EHE goals on the projected number and age distribution. AIM 2: To project the impact of reducing prominent risk factors on future multimorbidity burden. AIM 3: To estimate the cost effectiveness of interventions to reduce risk factors 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 and health services data within 15 PAH subgroups to guide clinical programs and informing healthcare resource allocations to ultimately improve the health of PAH in the US.