Can mental health services break the cycle perpetuating HIV hotspots in sub-Saharan Africa?

精神卫生服务能否打破撒哈拉以南非洲地区艾滋病毒热点的恶性循环？

• 批准号: 10580081
• 负责人: Anna Bershteyn
• 金额: $ 65.42万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-05-19 至 2026-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10580081
• 关键词: AIDS prevention; Adherence; Africa South of the Sahara; Anxiety; Area; Authorization documentation; Behavioral; Caring; Characteristics; Classification; Collaborations; Communities; Cost Effectiveness Analysis; Country; Data; Diagnosis; Ensure; Epidemic; Equilibrium; Feedback; Fractals; Geography; Goals; Growth; HIV; HIV risk; Health; Health Benefit; Health Personnel; Incidence; Infection; Investments; Kenya; Knowledge; Link; Location; Maps; Mathematics; Measurable; Measures; Mental Depression; Mental Health Services; Mental disorders; Methods; Modeling; Nature; Pattern; Persons; Phase; Policies; Prevalence; Prevention; Proliferating; Property; Recording of previous events; Research Personnel; Resources; Risk; Risk Behaviors; Role; Running; Sample Size; Services; Spottings; Sustainable Development; Taxonomy; Testing; Transact; Translations; Typology; United Nations; Variant; Visit; Work; Zambia; authority; common treatment; cost; cost effectiveness; demographics; epidemic response; frontier; high risk population; high risk sexual behavior; in silico; information gathering; mathematical model; pre-exposure prophylaxis; programs; response; scale up; screening; sex; simulation

ABSTRACT/SUMMARY HIV incidence is declining in sub-Saharan Africa (SSA), but some areas are not on track to achieve the “epidemic control” target of <0.1% annual rate of new infections set by the United Nations in the Sustainable Development Goals. Common mental disorders (CMD) such as depression and anxiety are extremely prevalent among people living with HIV, interfere with lifelong adherence to treatment, and are associated with risky sexual behaviors. Accordingly, health authorities in SSA are recognizing the importance of CMD screening and treatment as a component of HIV prevention, but have not yet determined where to focus these services. The areas at greatest risk of missing the epidemic control target are known as HIV hotspots. We hypothesize that there are different types of hotspots: some driven by risky behaviors, some arising by random chance, and some that emerged in the past and have become trapped in a positive feedback loop between incidence and prevalence. The optimal role of CMD screening and treatment may differ by hotspot type. We propose to use mathematical modeling to predict the occurrence of hotspots, determine how to classify them by type, and estimate the optimal role of CMD screening and treatment for each HIV hotspot type. Next, we will work with experts in two SSA countries – Kenya and Zambia – to develop an investment case for incorporating CMD screening and treatment into an optimal HIV response, either nationally or with a focus on HIV hotspots. Finally, we will use a value-of-information approach to determine whether the costs of finding and classifying hotspots are justified by the benefits of targeting and customizing the HIV response to each hotspot. We expect our project to guide Ministries of Health and implementers about scale-up of CMD treatment in SSA while also expanding basic understanding of HIV epidemics, which were hypothesized to contain hotspots due to fundamental mathematical properties such as fractals and chaos. These hypotheses have not been revisited in two decades, while geospatial HIV data and methods have proliferated. We expect that our project will enable more effective HIV prevention in SSA by expanding hotspot targeting and by facilitating the integration of CMD care into the HIV response.

摘要/总结 撒哈拉以南非洲 (SSA) 的艾滋病毒发病率正在下降，但一些地区尚未走上实现这一目标的正轨 联合国可持续发展框架下设定的年新增感染率<0.1%的“疫情控制”目标 抑郁症和焦虑症等常见精神障碍（CMD）的发展目标非常严重。 在艾滋病毒感染者中普遍存在，干扰终生坚持治疗，并与 因此，SSA 的卫生当局正在认识到 CMD 的重要性。 筛查和治疗作为艾滋病毒预防的一部分，但尚未确定将这些重点放在哪里 达不到疫情控制目标的风险最大的地区被称为艾滋病热点地区。 认为存在不同类型的热点：有些是由危险行为驱动的，有些是随机产生的 机会，有些是过去出现的，并陷入了之间的正反馈循环 CMD 筛查和治疗的最佳作用可能因热点类型而异。 我们建议使用数学模型来预测热点的出现，确定如何分类 按类型进行分类，并估计 CMD 筛查和治疗对每种 HIV 热点类型的最佳作用。 我们将与两个撒哈拉以南非洲国家（肯尼亚和赞比亚）的专家合作，制定投资案例 将 CMD 筛查和治疗纳入最佳艾滋病毒应对措施，无论是在全国范围内还是重点关注 最后，我们将使用信息价值方法来确定寻找艾滋病毒热点的成本。 对热点进行针对性和定制化艾滋病毒应对措施的好处是合理的。 我们希望我们的项目能够指导卫生部和实施者扩大 CMD。 SSA 的治疗，同时还扩大了对艾滋病毒流行病的基本了解，这些知识被重新纳入 由于分形和混沌等基本数学特性，这些假设包含热点。 二十年来没有被重新审视，而我们预计地理空间艾滋病毒数据和方法已经激增。 我们的项目将通过扩大热点目标和通过 促进将 CMD 护理纳入艾滋病毒应对措施。