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（由适用提供）：美国食品药品监督管理局（FDA）批准了2012年的第一个非处方家庭用途艾滋病毒测试。公共卫生部门已开始实施增加其使用计划以增加其使用；但是，这些测试对与男性发生性关系的男性（MSM）的艾滋病毒流行的潜在影响尚不清楚。这项研究的目的是告知公共卫生方法，以促进为MSM的潜水员种群促进安全有效的艾滋病毒测试策略。如果MSM使用否则不会测试或增加测试率，诊断和治疗率，则可以降低HIV HIV测试。但是，如果男性用家庭用途测试替换基于诊所的测试，则可以增加家庭使用测试，因为当可用测试的相对长窗户周期可能会导致急性感染期间的错误阴性测试，而当HIV感染者最感染时。如果在家中测试阳性的男性不寻求护理并及时启动抗逆转录病毒疗法（ART），则家庭使用测试也可能对感染者的健康产生负面影响，并对预防艾滋病毒构成挑战。男性可以在性交前与性伴侣一起进行家庭使用测试，以决定是否以及如何进行性爱[5]。如果合作伙伴更频繁地测试和基于更准确的信息，则这种性别点测试可能是有益的，但是如果男士根据不正确的有关血清的信息放弃避孕套，则可能会增加HIV风险。使用来自美国，西雅图和亚特兰大的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个人和伙伴关系水平上家庭使用HIV测试的不同策略如何影响HIV事件。首先，我们将开发一个参数，以代表MSM的新颖和异构HIV测试策略，并适应基于随机网络的HIV传播模型，以说明西雅图，华盛顿州西雅图市和佐治亚州亚特兰大的MSM的家庭使用测试策略和血清适应性行为。其次，我们将使用这些模型来确定最有效的个人家庭用途艾滋病毒测试策略，以提高对艾滋病毒感染的认识，并减少两种情况下MSM之间的艾滋病毒事件。第三，我们将预测家庭使用点HIV测试策略对西雅图与亚特兰大MSM中MSM中HIV感染和艾滋病毒感染的二元水平意识的影响。在此提案中，我们的模型类似于虚拟实验室：一种实用且具有成本效益的方法，用于检查家庭使用测试可以有效地减少潜水员高风险人群中的HIV事件的情况。此外，如果有必要进行此类倡议，我们的模型可以支持临床试验的设计，以测试家庭使用HIV测试干预措施的有效性。