The role of PrEP in Getting to Zero

项目总结/摘要 美国艾滋病预防中心的报告显示，美国艾滋病预防工作的进展已经停滞。 疾病控制和预防。最近，卫生与公众服务部已经做出了 将结束艾滋病毒流行作为国家优先事项，中期目标是在五年内减少75% 10年内减少90%。Getting to Zero（GTZ）计划依赖于组合的概念 艾滋病毒预防，采用根据当地需要量身定制的循证方法。其中， 这些计划强调暴露前预防（PrEP），这是一种多功能的工具，能够预防 在不同的艾滋病毒风险社区中获得艾滋病毒感染。尽管PrEP在疗效试验中取得了成功， 背景下，美国的吸收速度缓慢，变化很大：有PrEP适应症的人群的覆盖率 据估计，在美国各州，这一比例在5-41%之间（中位数为18%）。 基于代理的随机建模是高度装备调查复杂的流行病学问题，如 PrEP连续体在不同环境，人群中的影响，以及作为艾滋病毒预防组合的一部分。 HIV校准动态模型（HIV-CDM）模拟HIV检测、传播、治疗和 在广泛的流行病环境中进行预防，并能够解决PrEP面临的关键问题 在美国实施。利用艾滋病毒清洁发展机制，我们建议实现以下目标： 具体目标1：扩大和调整目前的艾滋病毒清洁发展机制，以捕捉流行动态、艾滋病毒风险 行为，网络混合，以及在最突出的GTZ计划中获得艾滋病毒预防模式 和优先设置在整个美国，使用经验数据，从正在进行和完成的研究， 男男性接触者、男男性行为者、注射毒品者和高危异性恋者。 具体目标2：在美国八个主要城市模拟PrEP连续体，包括PrEP资格， 特定人群、访问、保留和依从性。为这些模拟提供信息， 对于未来10年的PrEP利用，我们将整合每个步骤的经验数据， 连续体这将包括侧重于开发和测试各种PrEP资格措施， 包括基于电子健康记录的算法、临床检查表和CDC指南。 具体目标3：评估在五年内将艾滋病毒发病率降低75%和在十年内降低90%的潜力， 通过有针对性的PrEP扩展，在现有的组合预防包的背景下， 具有成功预防艾滋病毒的历史（例如，波士顿和弗朗西斯科），这些地方在 德国技术合作署的努力（迈阿密、亚特兰大）和大部分农村地区（伯明翰）是EHE的优先领域 倡议这种方法将包括基于网络的分析，将调查最有效的方法 在异质性流行病中提供PrEP。

PROJECT SUMMARY/ABSTRACT Progress in HIV prevention in the United States (US) has stalled, according to reports from the Centers for Disease Control and Prevention. Most recently, the Department of Health and Human Services has made Ending the HIV Epidemic (EHE) a national priority, with intermediate goals of a 75% reduction within five years and a 90% reduction in 10 years. Getting to Zero (GTZ) programs rely on the concept of combination HIV prevention, using evidence-based methods that have been tailored to suit local needs. Among each of these programs is an emphasis on pre-exposure prophylaxis (PrEP), which is a versatile tool able to prevent acquisition of HIV infection within diverse HIV-risk communities. Despite the success of PrEP in efficacy trial settings, uptake has been slow in the US and highly variable: coverage among those with indications for PrEP is estimated to range from 5-41% (median 18%), among US states. Agent-based stochastic modeling is highly equipped to investigate complex epidemiologic questions, such as the effects of the PrEP continuum in diverse settings, populations, and as part of combination HIV prevention. The HIV Calibrated Dynamic Model (HIV-CDM), simulates HIV testing, transmission, treatment, and prevention among a wide range of epidemic settings and is able to address the crucial questions facing PrEP implementation in the US. Using the HIV-CDM, we propose to address the following aims: Specific Aim 1: To expand and calibrate the current HIV-CDM to capture the epidemic dynamics, HIV risk behavior, network mixing, and access to HIV prevention modalities within the most prominent GTZ programs and priority settings throughout the US, using empirical data from ongoing and completed studies among MSM, men who have sex with men and women, people who inject drugs, and high-risk heterosexuals. Specific Aim 2: To simulate the PrEP continuum in eight key US cities, including PrEP eligibility within specific populations, access, retention, and adherence. To inform these simulations, and generate estimates for PrEP utilization up to 10 years into the future, we will integrate empirical data for each step of the continuum. This will include a focus on both the development and testing of diverse PrEP eligibility measures, including electronic health record-based algorithms, clinical checklists, and CDC guidelines. Specific Aim 3: To evaluate the potential to reduce HIV incidence by 75% in five years, and 90% in 10 years, through targeted PrEP expansion, within the context of existing combination prevention packages in settings with a history of HIV prevention successes (e.g., Boston and San Francisco), settings that have struggled in their GTZ efforts (Miami, Atlanta), and largely-rural settings (Birmingham) that are priority areas for the EHE initiative. This approach will include network-based analyses that will investigate the most efficient methods of PrEP delivery within heterogenous epidemics.