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.

项目概要/摘要 根据美国艾滋病毒预防中心的报告，美国艾滋病毒预防方面的进展已陷入停滞。 疾病控制和预防。最近，卫生与公共服务部做出了 结束艾滋病毒流行 (EHE) 成为国家优先事项，中期目标是在五年内减少 75% 年减少 90%，10 年内减少 90%。归零 (GTZ) 计划依赖于组合的概念 艾滋病毒预防，采用适合当地需求的循证方法。其中每一个 这些计划的重点是暴露前预防 (PrEP)，这是一种多功能工具，能够预防 在不同的艾滋病毒风险社区中获得艾滋病毒感染。尽管 PrEP 在疗效试验中取得了成功 在美国，采用率缓慢且变化很大：有 PrEP 指征的人群的覆盖率 美国各州的这一比例估计为 5-41%（中位数为 18%）。 基于主体的随机模型非常适合调查复杂的流行病学问题，例如 PrEP 连续体在不同环境、人群中的影响，以及作为艾滋病毒联合预防的一部分。 HIV 校准动态模型 (HIV-CDM) 模拟 HIV 检测、传播、治疗和 在广泛的流行病环境中进行预防，并能够解决 PrEP 面临的关键问题 在美国的实施。我们建议利用 HIV-CDM 实现以下目标： 具体目标 1：扩展和校准当前的 HIV-CDM，以捕捉流行病动态、HIV 风险 最重要的 GTZ 项目中的行为、网络混合和艾滋病毒预防模式的获取 和整个美国的优先设置，使用来自正在进行和已完成的研究的经验数据 MSM、男男性行为者、女同性恋者、注射吸毒者以及高危异性恋者。 具体目标 2：模拟美国八个主要城市的 PrEP 连续性，包括境内的 PrEP 资格 特定人群、访问、保留和依从性。为这些模拟提供信息并生成估计 对于未来 10 年内 PrEP 的利用，我们将整合每个步骤的经验数据 连续体。这将包括重点关注各种 PrEP 资格措施的开发和测试， 包括基于电子健康记录的算法、临床检查表和 CDC 指南。 具体目标 3：评估五年内将艾滋病毒发病率降低 75%、10 年内降低 90% 的潜力， 在现有组合预防方案的背景下，通过有针对性的 PrEP 扩展 具有艾滋病毒预防成功历史的地区（例如波士顿和旧金山），但在艾滋病毒预防方面一直举步维艰的地区 他们的 GTZ 工作（迈阿密、亚特兰大）和大部分农村地区（伯明翰）是 EHE 的优先领域 倡议。该方法将包括基于网络的分析，以研究最有效的方法 异质流行病中 PrEP 的传递。