Neilan Anne M, Patel Kunjal, Agwu Allison L, Bassett Ingrid V, Amico K Rivet, Crespi Catherine M, Gaur Aditya H, Horvath Keith J, Powers Kimberly A, Rendina H Jonathon, Hightow-Weidman Lisa B, Li Xiaoming, Naar Sylvie, Nachman Sharon, Parsons Jeffrey T, Simpson Kit N, Stanton Bonita F, Freedberg Kenneth A, Bangs Audrey C, Hudgens Michael G, Ciaranello Andrea L
Division of General Academic Pediatrics, Massachusetts General Hospital, Boston, MA, United States.
Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, United States.
JMIR Res Protoc. 2019 Apr 16;8(4):e9898. doi: 10.2196/resprot.9898.
The United States Centers for Disease Control and Prevention estimates that approximately 60,000 US youth are living with HIV. US youth living with HIV (YLWH) have poorer outcomes compared with adults, including lower rates of diagnosis, engagement, retention, and virologic suppression. With Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) support, new trials of youth-centered interventions to improve retention in care and medication adherence among YLWH are underway.
This study aimed to use a computer simulation model, the Cost-Effectiveness of Preventing AIDS Complications (CEPAC)-Adolescent Model, to evaluate selected ongoing and forthcoming ATN interventions to improve viral load suppression among YLWH and to define the benchmarks for uptake, effectiveness, durability of effect, and cost that will make these interventions clinically beneficial and cost-effective.
This protocol, ATN 161, establishes the ATN Modeling Core. The Modeling Core leverages extensive data-already collected by successfully completed National Institutes of Health-supported studies-to develop novel approaches for modeling critical components of HIV disease and care in YLWH. As new data emerge from ongoing ATN trials during the award period about the effectiveness of novel interventions, the CEPAC-Adolescent simulation model will serve as a flexible tool to project their long-term clinical impact and cost-effectiveness. The Modeling Core will derive model input parameters and create a model structure that reflects key aspects of HIV acquisition, progression, and treatment in YLWH. The ATN Modeling Core Steering Committee, with guidance from ATN leadership and scientific experts, will select and prioritize specific model-based analyses as well as provide feedback on derivation of model input parameters and model assumptions. Project-specific teams will help frame research questions for model-based analyses as well as provide feedback regarding project-specific inputs, results, sensitivity analyses, and policy conclusions.
This project was funded as of September 2017.
The ATN Modeling Core will provide critical information to guide the scale-up of ATN interventions and the translation of ATN data into policy recommendations for YLWH in the United States.
美国疾病控制与预防中心估计，约有6万名美国青少年感染了艾滋病毒。与成年人相比，美国感染艾滋病毒的青少年（YLWH）的治疗效果较差，包括诊断率、参与率、留存率和病毒学抑制率较低。在青少年艾滋病干预医学试验网络（ATN）的支持下，正在开展以青少年为中心的干预措施新试验，以提高YLWH的护理留存率和药物依从性。
本研究旨在使用计算机模拟模型“预防艾滋病并发症成本效益（CEPAC）-青少年模型”，评估选定的正在进行和即将开展的ATN干预措施，以提高YLWH的病毒载量抑制率，并确定干预措施的采用率、有效性、效果持久性和成本的基准，使这些干预措施具有临床益处和成本效益。
本方案（ATN 161）设立了ATN建模核心。建模核心利用已成功完成的美国国立卫生研究院支持的研究中收集的大量数据，开发新颖的方法来模拟YLWH中艾滋病毒疾病和护理的关键组成部分。在奖励期内，随着正在进行的ATN试验产生关于新干预措施有效性的新数据，CEPAC-青少年模拟模型将作为一个灵活的工具，预测其长期临床影响和成本效益。建模核心将推导模型输入参数，并创建一个反映YLWH中艾滋病毒感染、进展和治疗关键方面的模型结构。ATN建模核心指导委员会将在ATN领导层和科学专家的指导下，选择并确定基于模型的特定分析的优先级，并就模型输入参数和模型假设的推导提供反馈。特定项目团队将帮助确定基于模型的分析的研究问题，并就特定项目的输入、结果、敏感性分析和政策结论提供反馈。
该项目于2017年9月获得资助。
ATN建模核心将提供关键信息，以指导ATN干预措施的扩大，并将ATN数据转化为针对美国YLWH的政策建议。
