Modeling the Impact of HIV Prevention Interventions

描述（由申请人提供）：艾滋病毒流行病的增长是无情的，在人类健康和社会福利方面造成了毁灭性的损失。预防干预措施，包括艾滋病毒疫苗和其他行为和生物医学干预措施方面的挫折表明，确定有效的预防战略可能比预期的更加难以捉摸。理论上，人们可以进行随机临床试验（rct）来评估各种有希望的干预策略在减少个人和人群中艾滋病毒发病率方面的功效。然而，出于道德和后勤方面的原因，这是不可行的。长期随机临床试验的一个创新替代方案是使用随机建模，允许模拟各种干预措施，单独和组合，在一系列广泛的合理假设下评估它们对艾滋病毒发病率和流行率的影响。这项建议有以下三个具体目标：建立一个随机的，基于主体的HIV传播模型，通过纳入影响HIV传播的人群中的性行为来捕捉HIV传播动态的群体效应，将传播模型与非常成功的CEPAC US和CEPAC International模型联系起来，捕捉HIV疾病状态和传染性的影响，作为HIV RNA的功能，治疗耐药性，在资源有限的环境和美国坚持艾滋病毒传播，并在推出抗逆转录病毒治疗之前根据南非共和国和美国的数据校准模型。目标2：在南非共和国，评价初级、二级和综合艾滋病毒预防干预措施对人口层面衡量该流行病的效果（艾滋病毒发病率、流行率、预期寿命）、成本和成本效益的影响。目标3：在美国，评估初级、二级和联合艾滋病毒预防干预措施单独或联合对人口水平的影响（艾滋病毒发病率、流行率、质量调整预期寿命）、成本和成本效益。

DESCRIPTION (provided by applicant): The growth of the HIV epidemic has been relentless, taking a devastating toll in terms of human health and social welfare. Setbacks in prevention interventions, including HIV vaccines and other behavioral and biomedical interventions, suggest that identifying effective prevention strategies may prove even more elusive than anticipated. In theory, one might conduct randomized clinical trials (RCTs) to estimate the efficacy of various promising intervention strategies on reducing HIV incidence among individuals and populations. However, for ethical and logistical reasons this is not feasible. One innovative alternative to long-term, randomized clinical trials is the use of stochastic modeling to allow for the simulation of a variety of interventions, alone and in combination, to assess their impact on HIV incidence and prevalence under a wide array of plausible assumptions. This proposal has the following three specific aims: AIM1: To build a stochastic, agent-based HIV transmission model which captures the population effects of transmission dynamics of HIV by incorporating sexual behaviors within a population that affect HIV transmission, linking the transmission model to the highly successful CEPAC US and CEPAC International models to capture the effects of HIV disease state and infectivity as a function of HIV RNA, treatment resistance, and adherence on HIV transmission in resource limited settings and the US and to calibrate the model to data from both the Republic of South Africa and the US before ART roll out. AIM 2: In the Republic of South Africa, to evaluate the impact of primary, secondary and combination HIV prevention interventions on population level measures of effect (HIV incidence, prevalence, life expectancy), cost and cost-effectiveness) in the epidemic. AIM 3: In the US, to evaluate the impact of primary, secondary and combination HIV prevention interventions either alone or in combination, on population level measures of effect (HIV incidence, prevalence, quality adjusted life expectancy), cost and cost-effectiveness among MSMs. PUBLIC HEALTH RELEVANCE: The assembled research team has an extensive and proven record of publishing and disseminating findings that inform priority-setting in HIV care and practice guideline development, both in the US and internationally. By expanding the CEPAC treatment model, and accomplishing the specific aims described above, the team will bring innovative analysis to the most crucial HIV prevention policy questions that face providers and policy-makers throughout the world.