Projecting the age shift in HIV prevalence in sub-Saharan Africa: a necessary epidemiologic step to prepare for the silver tsunami

项目摘要 流行病学模型预测，到2040年，撒哈拉以南非洲27%的艾滋病毒感染者 (SSA)将是50岁或以上;然而，这些模型似乎低估了时间和 年龄变化的幅度。截至2022年，在接受抗逆转录病毒治疗（ART）的国家中， 总统艾滋病紧急救援计划的受益者年龄在50岁及以上。由于艾滋病毒在撒南非洲的流行 随着更多的艾滋病毒感染者（PLWH）被诊断出来，接受抗逆转录病毒治疗， 需要抑制更新的模型，以更准确地预测和规划未来的需求， 与艾滋病毒有关的保健系统。 艾滋病毒相关非传染性疾病的负担有据可查，风险显著上升 随年龄随着艾滋病毒/艾滋病感染者预期寿命的延长，医疗资源的限制，人们越来越关注 将非传染性疾病管理纳入艾滋病毒平台，必须在所有国家实现和维持艾滋病毒控制， 亚群，准确捕捉和预测PLWH的年龄分布和NCD负担的模型是 这对于解决知识差距和支持精确的计划实施至关重要。 我们认识到，艾滋病毒负担高的撒哈拉以南非洲国家将经历年龄分布向更大年龄分布的转变。 超过50%的50岁以上的PLWH至少比更常用的预测早十年 模型博茨瓦纳和赞比亚是两个具有不同流行特征的国家， 有机会开发和测试一个新的人口预测模型，以更准确地预测这一“银 艾滋病毒/艾滋病感染者和非传染性疾病负担中的“海啸”。这项研究的目的是使用重复的全国代表性的 来自博茨瓦纳和赞比亚的数据，以开发具有年龄分层传播风险的队列模型， 预测了到2050年艾滋病毒携带者的年龄分布和非传染性疾病负担。 建议的流行病学预测，以告知生活在老年人中的长期老龄化需求计划 艾滋病毒感染者（EPI-HIV）项目将产生一个准确预测年龄变化和 通过以下目标，提高艾滋病毒/艾滋病感染者老龄化人群的非传染性疾病风险： 博茨瓦纳和赞比亚使用重复的基于艾滋病毒人口的调查数据，2）建立一个年龄- 分层HIV传播风险，以预测PLWH随时间的年龄分布，以及3）预测 博茨瓦纳和赞比亚的艾滋病毒携带者和艾滋病患者的非传染性疾病负担。该项目的成果将用于 加快卫生系统的反应，并作为未来研究的基础， 撒哈拉以南非洲艾滋病毒携带者的非传染性疾病负担。

PROJECT SUMMARY Epidemiologic models have predicted that by 2040, 27% of the population living with HIV in sub-Saharan Africa (SSA) will be 50 years of age or older; however, these models appear to underestimate both the timing and magnitude of the age shift. As of 2022, 21% of all people on antiretroviral therapy (ART) in countries supported by the President's Emergency Plan for AIDS Relief are 50 years of age and older. As the HIV epidemic in SSA comes under control—with more people living with HIV (PLWH) diagnosed, placed on ART, and achieving viral suppression—updated models are needed to more accurately predict and plan for coming demands on the HIV-related healthcare system. The burden of HIV-associated noncommunicable diseases (NCD) is well documented, and risk rises markedly with age. With increases in life expectancy among PLWH, healthcare resource limitations, increased focus on integrating NCD management into HIV platforms, and the imperative to achieve and sustain HIV control in all subpopulations, models that accurately capture and predict the age distribution and NCD burden of PLWH are critical to address knowledge gaps and support precision program implementation. We posit that countries in SSA with high HIV burden will experience the shift in the age distribution to greater than 50% of PLWH over the age of 50 at least a decade sooner than predicted by more commonly used models. Botswana and Zambia are two settings with different epidemic characteristics, providing a unique opportunity to develop and test a new demographic prediction model for more accurate prediction of this “silver tsunami” in PLWH and NCD burden. The goal of this study is to use repeated nationally representative data from Botswana and Zambia to develop a cohort model with age-stratified transmission risk that predicts the age distribution and NCD burden among PLWH through 2050. The proposed Epidemiologic Predictions to Inform Programs for Long-term Aging Needs among people living with HIV (EPI-PLAN HIV) project will generate a framework for accurate prediction of both the age shift and NCD risk in aging populations of PLWH through the following aims 1) Characterize sexual networks in Botswana and Zambia using repeated HIV population-based survey data, 2) Build a cohort model with age- stratified HIV transmission risk to predict the age distribution among PLWH over time, and 3) Predict the burden of NCD among PLWH in Botswana and Zambia over time. The outcomes of this project will be used to accelerate the health system's response and serve as the foundation for future research into the growing burden of NCD in PLWH in SSA.