Projecting the age shift in HIV prevalence in sub-Saharan Africa: a necessary epidemiologic step to prepare for the silver tsunami

预测撒哈拉以南非洲艾滋病毒流行率的年龄变化：应对银色海啸的必要流行病学步骤

• 批准号: 10762075
• 负责人: Kristen A. Stafford
• 金额: $ 19.53万
• 依托单位: UNIVERSITY OF MARYLAND BALTIMORE
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-23 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10762075
• 关键词: 1 year old; Acceleration; Achievement; Acquired Immunodeficiency Syndrome; Address; Africa South of the Sahara; African; Age; Age Distribution; Age Years; Aging; Botswana; Caring; Categories; Characteristics; Complex; Country; Data; Diabetes Mellitus; Diagnosis; Disease; Disease Management; Emergency Situation; Epidemic; Epidemiology; Foundations; Goals; HIV; HIV diagnosis; Health; Health system; Healthcare; Healthcare Systems; Hypertension; Incidence; Institution; Kidney Diseases; Knowledge; Letters; Life Expectancy; Malignant neoplasm of cervix uteri; Modeling; Network-based; Outcome; Participant; Persons; Population; Prevalence; Probability; Research; Research Personnel; Resources; Risk; Sexual Partners; Silver; Survey Methodology; Surveys; Testing; Time; Training; Tsunami; Update; Viral; Work; Zambia; age group; age stratification; antiretroviral therapy; burden of illness; cohort; disorder risk; epidemic response; epidemiological model; experience; mortality; population based; predictive modeling; programs; response; risk prediction; sex; transmission process

PROJECT SUMMARY Epidemiologic models have predicted that by 2040, 27% of the population living with HIV in sub-Saharan Africa (SSA) will be 50 years of age or older; however, these models appear to underestimate both the timing and magnitude of the age shift. As of 2022, 21% of all people on antiretroviral therapy (ART) in countries supported by the President's Emergency Plan for AIDS Relief are 50 years of age and older. As the HIV epidemic in SSA comes under control—with more people living with HIV (PLWH) diagnosed, placed on ART, and achieving viral suppression—updated models are needed to more accurately predict and plan for coming demands on the HIV-related healthcare system. The burden of HIV-associated noncommunicable diseases (NCD) is well documented, and risk rises markedly with age. With increases in life expectancy among PLWH, healthcare resource limitations, increased focus on integrating NCD management into HIV platforms, and the imperative to achieve and sustain HIV control in all subpopulations, models that accurately capture and predict the age distribution and NCD burden of PLWH are critical to address knowledge gaps and support precision program implementation. We posit that countries in SSA with high HIV burden will experience the shift in the age distribution to greater than 50% of PLWH over the age of 50 at least a decade sooner than predicted by more commonly used models. Botswana and Zambia are two settings with different epidemic characteristics, providing a unique opportunity to develop and test a new demographic prediction model for more accurate prediction of this “silver tsunami” in PLWH and NCD burden. The goal of this study is to use repeated nationally representative data from Botswana and Zambia to develop a cohort model with age-stratified transmission risk that predicts the age distribution and NCD burden among PLWH through 2050. The proposed Epidemiologic Predictions to Inform Programs for Long-term Aging Needs among people living with HIV (EPI-PLAN HIV) project will generate a framework for accurate prediction of both the age shift and NCD risk in aging populations of PLWH through the following aims 1) Characterize sexual networks in Botswana and Zambia using repeated HIV population-based survey data, 2) Build a cohort model with age- stratified HIV transmission risk to predict the age distribution among PLWH over time, and 3) Predict the burden of NCD among PLWH in Botswana and Zambia over time. The outcomes of this project will be used to accelerate the health system's response and serve as the foundation for future research into the growing burden of NCD in PLWH in SSA.

项目摘要 流行病学模型已经预测，到2040年，撒哈拉以南非洲的艾滋病毒的27％ （SSA）年龄在50岁以上；但是，这些模型似乎低估了时机和 年龄变化的幅度。截至2022年，在支持国家的所有抗逆转录病毒疗法（ART）中，有21％的人支持 总统的紧急艾滋病救济计划年龄较高50岁。作为SSA的HIV流行 受到控制 - 越来越多的患者诊断出艾滋病毒（PLWH），享受艺术并实现病毒 抑制 - 需要更新的模型，以更准确地预测和计划即将到来的需求 与HIV相关的医疗系统。 艾滋病毒相关的非通信疾病（NCD）的伯宁有据可查，风险明显增加 随着年龄的增长。随着PLWH之间的预期寿命增加，医疗保健资源限制，对 将NCD管理整合到HIV平台中，以及在所有人中实现和维持HIV控制的必要性 亚群，准确捕获和预测PLWH的年龄分布和NCD伯宁的模型是 解决知识差距和支持精确计划实施的至关重要。 我们指出，SSA的艾滋病毒高伯恩的国家将经历年龄分布的转变 至少比更常用的预测，超过50岁以上PLWH的50％ 型号。博茨瓦纳和赞比亚是两个具有不同流行特征的环境，提供了独特的 开发和测试新的人口预测模型的机会，以更准确地预测“银牌” PLWH和NCD Burnen中的海啸”。这项研究的目的是反复使用全国代表。 来自博茨瓦纳和赞比亚的数据开发了具有年龄分层的传播风险的队列模型 直到2050年，可以预测PLWH的年龄分布和NCD燃烧。 拟议的流行病学预测，以为生活中的长期衰老需求提供信息 随着艾滋病毒（Epi-Plans HIV）项目，将生成一个框架，以准确预测年龄变化和 通过以下目的，PLWH老化人群的NCD风险1）表征性网络 博茨瓦纳和赞比亚使用重复基于HIV的调查数据，2）与年龄建立队列模型 分层的HIV传播风险可以预测PLWH随着时间的推移的年龄分布，3）预测 随着时间的流逝，波茨瓦纳和赞比亚的NCD负担。该项目的结果将用于 加速卫生系统的反应，并作为对不断增长的未来研究的基础 SSA中PLWH的NCD负担。