A computer simulation of the Sub-Saharan HIV pandemic that can estimate benefit a

描述（由申请人提供）：NIAAA PA-07-028要求研究识别和建模“酒精消费模式对艾滋病毒感染传播的影响和相关的机会性感染随着时间的推移”和“预防与酒精有关的艾滋病毒风险行为”。“此外，NIAAA的研究目标越来越多地针对资源贫乏的环境，因为它们的疾病负担不成比例。为了解决这些优先事项，我们的目标是创建一个艾滋病毒流行病的计算机模拟，可以评估在撒哈拉以南非洲的NIAAA资助的干预措施的好处和价值。为了确保该模型反映了撒哈拉以南非洲的临床现实以及正在研究的酒精干预措施的具体特点，我们组建了一个由建模人员、酒精专家、艾滋病专家、统计学家和流行病学家组成的多学科团队;其中包括正在研究的NIAAA资助的酒精干预措施的两名PI。几乎所有的研究团队成员都在撒哈拉以南非洲地区拥有丰富的临床护理或研究经验。我们将使用NIAID资助的34，000名患者的国际流行病学数据库评估艾滋病（IEDEA）队列，以确保模拟具有良好的预测有效性，我们将设计模拟以代表撒哈拉以南非洲艾滋病毒传播的重要社会特征（例如，性传播感染流行率高、社会网络特征等）。在构建模拟并确定它可以预测撒哈拉以南地区的个人水平和人群水平的结果后，我们将使用模拟来调查NIAAA资助的干预措施是否（1）导致临床显著的益处，（2）提供比WHO指南更大的价值，以及（3）提供比当前护理更大的价值。建模是一种特别适合评估NIAAA资助的撒哈拉以南非洲干预措施价值的方法，因为临床试验仅提供短期行为数据，在“公平竞争环境”中比较其益处和价值需要估计长期临床结果。 国家酒精中毒和酒精滥用研究所正在研究多种方法，以减少世界上艾滋病毒传播风险最高的地区的酒精滥用和无保护性行为。然而，资源非常有限，我们不知道这些方法中哪一种提供最大的价值。这项研究旨在使用经过充分测试的计算机模拟方法来帮助我们评估和比较不同方法预防艾滋病毒传播的价值，重点是专门针对酗酒的方法。

DESCRIPTION (provided by applicant): NIAAA PA-07-028 calls for studies to identify and model "the impact of alcohol consumption patterns on the spread of HIV infection and associated opportunistic infections over time" and "the prevention of HIV risk behaviors related to alcohol." In addition, NIAAA research objectives are increasingly targeting resource- poor settings because of their disproportionate burden of disease. To address these priorities, we aim to create a computer simulation of the HIV pandemic that can evaluate the benefit and value of NIAAA-funded interventions in Sub-Saharan Africa. To ensure that this model reflects the clinical realities of Sub-Saharan Africa as well as the particular features of the alcohol interventions under study, we have assembled a multidisciplinary team of modelers, alcohol experts, HIV experts, statisticians, and epidemiologists; including two PIs of the NIAAA-funded alcohol interventions that are under study. Virtually all of the study team members have extensive experience with clinical care or research in Sub-Saharan Africa. We will use the NIAID-funded, 34,000-patient, International Epidemiologic Databases to Evaluate AIDS (IeDEA) cohort to ensure that the simulation has good predictive validity, and we will design the simulation to represent important social features of HIV transmission in Sub-Saharan Africa (e.g., high prevalence of sexually transmitted infections, social network characteristics, etc). After constructing the simulation and ascertaining that it can predict individual- level and population-level Sub-Saharan outcomes, we will use the simulation to investigate whether NIAAA- funded interventions (1) lead to clinically significant benefits, (2) deliver greater value than WHO guidelines, and (3) deliver greater value than current care. Modeling is a method that is particularly well suited to assess the value of NIAAA-funded Sub-Saharan interventions because clinical trials will only provide short-term behavioral data, and comparing their benefit and value on a "level playing field" requires estimation of longer- term clinical outcomes. The National Institute of Alcoholism and Alcohol Abuse is studying many ways to decrease alcohol abuse and unprotected sex in regions of the world where HIV transmission risk is the highest. However, resources are very limited and we do not know which of these methods deliver the greatest value. This study aims to use well-tested computer simulation methods to help us assess and compare the value of different methods for preventing HIV transmission, with a focus on methods that specifically target alcohol abuse.