Miami Dade County ASsessment of Phylogenetics to Improve Resource Equity: MD ASPIRE

摘要 终止艾滋病毒流行（EHE）倡议的大胆目标是将高负担地区的艾滋病毒发病率降低90% 到2030年，在衡量发病率以确定优先人群和了解如何最好地 分配当地资源。到目前为止，基于艾滋病毒分子监测的干预措施尚未与艾滋病毒/艾滋病相关。 降低艾滋病毒感染率。也就是说（除了极少数例外），公共卫生工作针对个人相关 随着艾滋病毒传播集群的迅速增长， 或在提供这些服务的地区或群体中病毒抑制的人数比例。 没有现有的资源分配模型，由当地分子和艾滋病毒规划数据告知， 确定如何最好地分配与EHE目标相关的资源。“洛杉矶县评估 改善资源公平性的系统动力学（LAC ASPIRE）”团队将使用i）高级系统动力学 确定传播率最高人群的方法和预期发病率计量 在洛杉矶县（LAC）和ii）经济建模，以优化公共卫生计划资源的分配 实现EHE和其他利益相关者的目标。ASPIRE团队是一个研究人员之间的伙伴关系， 一些学术大学和拉丁美洲和加勒比艾滋病毒和性传播疾病方案司（DHSP）。分析将使用编码的 以及拉丁美洲和加勒比地区卫生和安全方案提供的艾滋病毒监测数据和方案数据。拟定的研究将 确定传播率最高的拉丁美洲和加勒比人口，并将其列为重点人口。我们将使用 经济建模，以制定优化预防资源分配的战略，i）减少艾滋病毒 发病率，ii）改善与艾滋病毒有关的健康结果，iii）改善人口之间的公平性。我们会委聘 艾滋病毒感染者-定义为1）拉加地区卫生和战略计划人员，2）直接或间接参与艾滋病毒管理的人员 拉丁美洲和加勒比地区的方案，以及3）艾滋病毒感染者（PWH）和其他主要受影响人群-提供以下方面的指导 人口和资源优先战略，既为区域所接受，又最有可能实现 EHE目标。 总体研究目标是开发一个流程，以指导与艾滋病毒项目分配相关的决策 公共卫生部门根据区域方案和传播数据提供的资源。项目特定 目标1（识别）。确定艾滋病毒预防工作的最优先重点人群（这些 数据将告知目标2中使用的流行病模型）;目标2（分配）。开发用户友好的动态 传输模型，该模型将预测资源优化配置的替代战略的影响， 拉丁美洲和加勒比艾滋病毒预防方案（这些数据将预测健康结果和成本效益）;以及目标3 （订婚）。让主要利益攸关方参与制定一个程序，以指导项目成果，并在 LAC卫生部的数据分析，包括目标1和2的方法。

ABSTRACT The Ending the HIV Epidemic (EHE) Initiative boldly aims to reduce HIV incidence in high burden areas by 90% by 2030, yet challenges remain in measuring incidence to identify priority populations and knowing how to best allocate local resources. To date, HIV molecular surveillance-based interventions have not been linked to a reduction in HIV incidence. That is (with rare exception), public health efforts directed to individuals associated with rapidly growing HIV transmission clusters have not been shown to reduce the number of new HIV infections or the proportion of people virally suppressed in the regions or groups where these services were delivered. There are no existing resource allocation models that are informed by local molecular and HIV program data to determine how to best allocate resources relevant to EHE targets. The “Los Angeles County ASsessment of Phylodynamics to Improve Resource Equity (LAC ASPIRE)” team will use i) advanced phylodynamic approaches and prospective measures of incidence to identify populations with the highest transmission rates in Los Angeles County (LAC) and ii) economic modeling to optimize allocation of public health program resources to achieve EHE and other stakeholder targets. The ASPIRE team is a partnership between investigators at several academic universities and the LAC Division of HIV and STD Programs (DHSP). Analyses will use coded and de-identified HIV surveillance data and program data provided by the LAC DHSP. The proposed study will identify LAC populations with the highest transmission rates and denote as priority populations. We will use economic modeling to develop strategies that optimize the allocation of prevention resources to i) reduce HIV incidence, ii) improve HIV-related health outcomes, and iii) improve equity across populations. We will engage stakeholders—defined as 1) LAC DHSP personnel, 2) those directly or indirectly involved in administering HIV Programs in LAC, and 3) persons with HIV (PWH) and other key affected populations—to provide guidance on population and resource prioritization strategies that are both regionally acceptable and most likely to achieve EHE targets. The overall study objective is to develop a process to guide decision-making related to allocation of HIV program resources by public health departments informed by regional program and transmission data. Project specific aims include: Aim 1 (IDENTIFY). Identify populations that are the highest priority for HIV prevention efforts (these data will inform the epidemic model used in Aim 2); Aim 2 (ALLOCATE). Develop a user-friendly dynamic transmission model that will project the impact of alternative strategies for the optimal allocation of resources to LAC HIV prevention programs (these data will project health outcomes and cost-effectiveness); and Aim 3 (ENGAGE). Engage key stakeholders to develop a process to guide project outcomes and build capacity at the LAC Health Department for data analysis that incorporates Aim 1 and 2 methods.