The role of PrEP in Getting to Zero

PrEP 在“零”目标中的作用

• 批准号: 10619134
• 负责人: Daniel Escudero
• 金额: $ 87.95万
• 依托单位: VANDERBILT UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-05-04 至 2027-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10619134
• 关键词: AIDS prevention; Address; Adherence; Algorithms; Area; Awareness; Behavioral; Black Populations; Boston; Calibration; Caring; Centers for Disease Control and Prevention (U.S.); Cities; Clinical; Communities; Complex; Continuity of Patient Care; Country; Couples; Data; Development; Electronic Health Record; Eligibility Determination; Enrollment; Epidemic; Epidemiology; Face; Future; Goals; Guidelines; HIV; HIV Infections; HIV diagnosis; HIV risk; Heterosexuals; Hispanic Populations; Human immunodeficiency virus test; Incidence; Injecting drug user; International; Investments; Location; Measures; Methods; Modality; Modeling; Monitor; Network-based; New York City; Phase; Policies; Policy Maker; Population; Prevention; Prevention Guidelines; Publishing; Randomized; Recording of previous events; Reporting; Research; Risk Behaviors; Role; San Francisco; Testing; United States; United States Dept. of Health and Human Services; Viral; access disparities; antiretroviral therapy; black women; condoms; efficacy trial; epidemiological model; evidence base; high risk; high risk population; innovation; men who have sex with men; men who have sex with men and women; metropolitan; pre-exposure prophylaxis; prevent; programs; rural setting; simulation; success; tool; transgender women; transmission process; uptake; young men who have sex with men

PROJECT SUMMARY/ABSTRACT Progress in HIV prevention in the United States (US) has stalled, according to reports from the Centers for Disease Control and Prevention. Most recently, the Department of Health and Human Services has made Ending the HIV Epidemic (EHE) a national priority, with intermediate goals of a 75% reduction within five years and a 90% reduction in 10 years. Getting to Zero (GTZ) programs rely on the concept of combination HIV prevention, using evidence-based methods that have been tailored to suit local needs. Among each of these programs is an emphasis on pre-exposure prophylaxis (PrEP), which is a versatile tool able to prevent acquisition of HIV infection within diverse HIV-risk communities. Despite the success of PrEP in efficacy trial settings, uptake has been slow in the US and highly variable: coverage among those with indications for PrEP is estimated to range from 5-41% (median 18%), among US states. Agent-based stochastic modeling is highly equipped to investigate complex epidemiologic questions, such as the effects of the PrEP continuum in diverse settings, populations, and as part of combination HIV prevention. The HIV Calibrated Dynamic Model (HIV-CDM), simulates HIV testing, transmission, treatment, and prevention among a wide range of epidemic settings and is able to address the crucial questions facing PrEP implementation in the US. Using the HIV-CDM, we propose to address the following aims: Specific Aim 1: To expand and calibrate the current HIV-CDM to capture the epidemic dynamics, HIV risk behavior, network mixing, and access to HIV prevention modalities within the most prominent GTZ programs and priority settings throughout the US, using empirical data from ongoing and completed studies among MSM, men who have sex with men and women, people who inject drugs, and high-risk heterosexuals. Specific Aim 2: To simulate the PrEP continuum in eight key US cities, including PrEP eligibility within specific populations, access, retention, and adherence. To inform these simulations, and generate estimates for PrEP utilization up to 10 years into the future, we will integrate empirical data for each step of the continuum. This will include a focus on both the development and testing of diverse PrEP eligibility measures, including electronic health record-based algorithms, clinical checklists, and CDC guidelines. Specific Aim 3: To evaluate the potential to reduce HIV incidence by 75% in five years, and 90% in 10 years, through targeted PrEP expansion, within the context of existing combination prevention packages in settings with a history of HIV prevention successes (e.g., Boston and San Francisco), settings that have struggled in their GTZ efforts (Miami, Atlanta), and largely-rural settings (Birmingham) that are priority areas for the EHE initiative. This approach will include network-based analyses that will investigate the most efficient methods of PrEP delivery within heterogenous epidemics.

项目摘要/摘要 根据中心的报告，美国（美国）的艾滋病毒预防进展已停滞 疾病控制和预防。最近，卫生与公共服务部已成为 结束艾滋病毒流行（EHE）的国家优先事项，中间目标降低了75％ 年份和10年内减少了90％。达到零（GTZ）程序依赖组合的概念 艾滋病毒预防，使用针对当地需求量身定制的循证方法。每个 这些程序强调预防前预防（PREP），这是一种能够防止的多功能工具 在各种艾滋病毒危机社区内收购艾滋病毒感染。尽管在功效试验中取得了成功 在美国的设置，吸收很慢，可变程度很大：覆盖范围的覆盖范围 在美国各州中，估计范围为5-41％（中位18％）。 基于代理的随机建模具有高度能够研究复杂的流行病学问题，例如 预科连续体在各种环境，人群中的影响，也是预防HIV组合的一部分。 HIV校准的动态模型（HIV-CDM）模拟HIV测试，传播，治疗和 在广泛的流行环境中预防，能够解决PREP面临的关键问题 在美国实施。使用HIV-CDM，我们建议解决以下目的： 特定目标1：扩展和校准当前的HIV-CDM以捕获流行动力学，HIV风险 在最突出的GTZ计划中的行为，网络混合和访问HIV预防方式 以及美国各地的优先设置，使用来自正在进行和完成的研究的经验数据 MSM，与男人和女人发生性关系的男人，注入毒品的人以及高风险的异性恋者。 具体目标2：模拟美国八个主要城市的准备连续性，包括 特定人群，访问，保留和依从性。告知这些模拟并产生估算值 对于未来最多10年的预备利用，我们将在每个步骤的每个步骤中整合经验数据 连续。这将包括关注多种准备资格措施的开发和测试， 包括基于电子记录的算法，临床清单和CDC指南。 特定目标3：评估五年内将艾滋病毒发病率降低75％的潜力，十年内90％ 通过有针对性的准备扩展，在设置中现有组合预防包的背景下 具有预防艾滋病毒的历史（例如，波士顿和旧金山），苦苦挣扎的环境 他们的GTZ努力（迈阿密，亚特兰大）和主要农村环境（伯明翰）是优先领域 倡议。这种方法将包括基于网络的分析，这些分析将研究最有效的方法 异质流行病中的准备递送。