Mathematical models to inform effective home-use HIV testing strategies for MSM

为 MSM 提供有效的家庭 HIV 检测策略的数学模型

基本信息

批准号：
8992747
负责人：
SUSAN LYNN CASSELS
金额：
$ 21.36万
依托单位：
UNIVERSITY OF CALIFORNIA SANTA BARBARA
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-07-05 至 2017-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8992747
关键词：
AIDS prevention Accounting Acute Address Affect Anus Awareness Behavior Cities Clinic Clinical Trials Design Data Data Analyses Decision Making Diagnosis Effectiveness Effectiveness of Interventions Epidemic Epidemiology Frequencies HIV HIV Infections HIV risk Health Home environment Human immunodeficiency virus test Incidence Individual Infection Intervention Laboratories Modeling Network-based Outcome Persons Population Population Heterogeneity Public Health Quality of Care Race Research Risk Risk Behaviors Running Sexual Partners Subgroup Techniques Testing Time United States Food and Drug Administration Work antiretroviral therapy base behavior test care seeking condoms cost effective high risk improved man mathematical model men men who have sex with men network models novel outreach programs public health intervention public health relevance randomized trial sex tool transmission process uptake virtual

项目摘要

DESCRIPTION (provided by applicant): The U.S. Food and Drug Administration (FDA) approved the first over-the-counter home-use HIV test in 2012. Public health departments have started to implement programs to increase their use; however, the potential impact of these tests on the HIV epidemic among men who have sex with men (MSM) is unknown. The aim of this research is to inform public health approaches to promote safe and effective home-use HIV testing strategies for diverse populations of MSM. Home-use HIV tests may reduce HIV incidence if used by MSM who would otherwise not test or if they increase rates of testing, diagnosis and treatment. However, home-use tests may increase transmission if men replace clinic-based tests with home-use tests because the relatively long window period of available tests can result in false-negative tests during acute infection when HIV-infected persons are most infectious. Home-use tests may also negatively impact the infected individual's health and pose a challenge for HIV prevention if men who test positive at home do not seek care and initiate antiretroviral therapy (ART) in a timely manner. Men may use home-use tests with sex partners prior to sex to make decisions about whether and how to have sex [5]. Such point-of-sex testing may be beneficial if partners test more often and seroadapt based on more accurate information but may increase HIV risk if men forgo condoms based on incorrect information about serostatus. Using data from two different epidemiologic settings in the U.S., Seattle and Atlanta, we will use mathematical models to estimate how different strategies of home-use HIV testing at the individual and partnership levels affects HIV incidence. First, we will develop a se of parameters to represent novel and heterogeneous HIV testing strategies for MSM, and adapt, expand, and validate a stochastic network-based HIV transmission model to account for home-use testing strategies and seroadaptive behavior for MSM in Seattle, WA and Atlanta, GA. Second, we will use the models to identify the most effective individual home-use HIV testing strategies to increase awareness of HIV infection and reduce HIV incidence among MSM in the two settings. Third, we will predict the impact of home-use point-of-sex HIV testing strategies on dyadic-level awareness of HIV infection and HIV incidence among MSM in Seattle versus Atlanta. In this proposal, our models are akin to a virtual laboratory: a practical and cost-effective way to examine the scenarios under which home-use testing can effectively reduce HIV incidence in diverse high-risk populations. Moreover, our models can support the design of clinical trials to test the effectiveness of home-use HIV testing interventions if such an initiatie is warranted.

描述（由申请人提供）：美国食品和药物管理局 (FDA) 于 2012 年批准了第一个非处方家用 HIV 检测。公共卫生部门已开始实施增加其使用的计划，但是潜在的影响；这些检测对男男性接触者 (MSM) 中艾滋病毒流行情况的影响尚不清楚。这项研究的目的是为公共卫生方法提供信息，以促进针对不同的男男性接触者群体使用安全有效的家庭艾滋病毒检测策略。如果男男性接触者使用检测，否则他们不会进行检测，或者如果检测增加检测、诊断和治疗的比率，则可能会降低艾滋病毒的发病率。但是，如果男性用家庭检测代替临床检测，则家庭检测可能会增加传播，因为相对来说，家庭检测可能会增加传播率。可用检测的长窗口期可能会导致艾滋病毒感染者传染性最强的急性感染期间出现假阴性检测，如果男性在艾滋病毒感染者传染性最强的情况下检测呈阳性，则家庭使用的检测也可能对感染者的健康产生负面影响，并对艾滋病毒的预防构成挑战。在家不寻求护理并开始抗逆转录病毒治疗(ART) 男性可以在性行为前与性伴侣一起使用家庭测试来决定是否以及如何发生性行为 [5]。和seroadapt基于更准确的信息，但如果男性基于有关血清状态的错误信息放弃安全套，可能会增加艾滋病毒风险。使用来自美国西雅图和亚特兰大两个不同流行病学环境的数据，我们将使用数学模型来估计不同的家庭策略如何影响。 -使用首先，我们将开发一系列参数来代表 MSM 的新颖且异质的 HIV 检测策略，并调整、扩展和验证基于随机网络的 HIV 传播模型。其次，我们将使用这些模型来确定最有效的个人家用 HIV 检测策略，以提高 MSM 中的 HIV 感染意识并降低 HIV 发病率。第三，在两个设置中。我们将预测西雅图和亚特兰大的家庭使用性点 HIV 检测策略对 MSM 的 HIV 感染和 HIV 发病率的二元意识的影响。在本提案中，我们的模型类似于虚拟实验室：一个实用的实验室。此外，我们的模型可以支持临床试验的设计，以测试家庭使用艾滋病毒检测干预措施的有效性。这样的举措是有道理的。