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.

项目概要 流行病学模型预测，到 2040 年，撒哈拉以南非洲地区 27% 的人口感染艾滋病毒 (SSA) 将年满 50 岁；然而，这些模型似乎低估了时机和年龄。 截至 2022 年，接受抗逆转录病毒治疗 (ART) 的国家中有 21% 的人支持 由于艾滋病毒在撒哈拉以南非洲流行，根据总统艾滋病紧急救援计划，年龄在 50 岁及以上的人。 得到控制——更多的艾滋病毒感染者 (PLWH) 得到诊断、接受抗逆转录病毒治疗并实现病毒传播 抑制——需要更新模型来更准确地预测和规划未来的需求 与艾滋病毒相关的医疗保健系统。 与艾滋病毒相关的非传染性疾病 (NCD) 的负担已得到充分记录，且风险显着上升 随着年龄的增长，艾滋病患者预期寿命的增加，医疗资源的限制，人们越来越关注 将非传染性疾病管理纳入艾滋病毒平台，以及在所有国家实现和维持艾滋病毒控制的必要性 亚人群、准确捕获和预测 PLWH 年龄分布和非传染性疾病负担的模型 对于解决知识差距和支持精确计划实施至关重要。 我们认为，撒哈拉以南非洲地区艾滋病毒负担较高的国家将经历年龄分布向更大范围的转变。 超过 50% 的 50 岁以上的 PLWH 比更常用的预测至少早十年 博茨瓦纳和赞比亚是两个具有不同流行特征的国家，提供了独特的模式。 有机会开发和测试新的人口预测模型，以便更准确地预测这种“白银” PLWH 和非传染性疾病负担中的“海啸” 本研究的目标是使用重复的全国代表性。 来自博茨瓦纳和赞比亚的数据用于开发具有年龄分层传播风险的队列模型 预测到 2050 年 PLWH 的年龄分布和非传染性疾病负担。 拟议的流行病学预测可为居住者长期老龄化需求的计划提供信息 HIV 感染者 (EPI-PLAN HIV) 项目将生成一个框架，用于准确预测年龄变化和 通过以下目标降低老龄化 PLWH 人群中的非传染性疾病风险 1) 描述性网络的特征 博茨瓦纳和赞比亚使用重复的基于艾滋病毒人群的调查数据，2）建立一个年龄组模型 分层 HIV 传播风险来预测 PLWH 随时间的年龄分布，以及 3) 预测 随着时间的推移，博茨瓦纳和赞比亚艾滋病感染者的非传染性疾病负担将被用于： 加快卫生系统的反应，并为未来研究不断增长的疾病奠定基础 SSA 的 PLWH 的非传染性疾病负担。