Health Economic Research Unit at the British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.
Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
PLoS One. 2019 May 30;14(5):e0217559. doi: 10.1371/journal.pone.0217559. eCollection 2019.
Dynamic HIV transmission models can provide evidence-based guidance on optimal combination implementation strategies to treat and prevent HIV/AIDS. However, these models can be extremely data intensive, and the availability of good-quality data characterizing regional microepidemics varies substantially within and across countries. We aim to provide a comprehensive and transparent description of an evidence synthesis process and reporting framework employed to populate and calibrate a dynamic, compartmental HIV transmission model for six US cities.
We executed a mixed-method evidence synthesis strategy to populate model parameters in six categories: (i) initial HIV-negative and HIV-infected populations; (ii) parameters used to calculate the probability of HIV transmission; (iii) screening, diagnosis, treatment and HIV disease progression; (iv) HIV prevention programs; (v) the costs of medical care; and (vi) health utility weights for each stage of HIV disease progression. We identified parameters that required city-specific data and stratification by gender, risk group and race/ethnicity a priori and sought out databases for primary analysis to augment our evidence synthesis. We ranked the quality of each parameter using context- and domain-specific criteria and verified sources and assumptions with our scientific advisory committee.
To inform the 1,667 parameters needed to populate our model, we synthesized evidence from 59 peer-reviewed publications and 24 public health and surveillance reports and executed primary analyses using 11 data sets. Of these 1,667 parameters, 1,517 (91%) were city-specific and 150 (9%) were common for all cities. Notably, 1,074 (64%), 201 (12%) and 312 (19%) parameters corresponded to categories (i), (ii) and (iii), respectively. Parameters ranked as best- to moderate-quality evidence comprised 39% of the common parameters and ranged from 56%-60% across cities for the city-specific parameters. We identified variation in parameter values across cities as well as within cities across risk and race/ethnic groups.
Better integration of modelling in decision making can be achieved by systematically reporting on the evidence synthesis process that is used to populate models, and by explicitly assessing the quality of data entered into the model. The effective communication of this process can help prioritize data collection of the most informative components of local HIV prevention and care services in order to reduce decision uncertainty and strengthen model conclusions.
动态 HIV 传播模型可以为最佳组合实施策略提供循证指导，以治疗和预防 HIV/AIDS。然而，这些模型可能需要大量数据，并且描述区域微观疫情的高质量数据在国家内部和国家之间存在很大差异。我们旨在提供一个全面透明的描述，说明用于填充和校准六个美国城市的动态、隔室 HIV 传播模型的证据综合过程和报告框架。
我们执行了一种混合方法证据综合策略，以填充六个类别的模型参数：（i）初始 HIV 阴性和 HIV 感染人群；（ii）用于计算 HIV 传播概率的参数；（iii）筛查、诊断、治疗和 HIV 疾病进展；（iv）HIV 预防计划；（v）医疗保健成本；以及（vi）HIV 疾病进展各个阶段的健康效用权重。我们确定了需要城市特定数据和按性别、风险群体和种族/族裔分层的参数，并事先寻找数据库进行主要分析，以补充我们的证据综合。我们使用上下文和领域特定标准对每个参数的质量进行排名，并与我们的科学顾问委员会一起验证来源和假设。
为了为我们的模型填充 1667 个参数，我们综合了 59 篇同行评议出版物和 24 份公共卫生和监测报告的证据，并使用 11 个数据集进行了主要分析。在这 1667 个参数中，1517 个（91%）是特定于城市的，150 个（9%）是所有城市共有的。值得注意的是，分别有 1074 个（64%）、201 个（12%）和 312 个（19%）参数对应于类别（i）、（ii）和（iii）。排名最佳至中等质量证据的参数占共有参数的 39%，在特定于城市的参数中，各城市的比例从 56%-60%不等。我们发现了城市之间以及城市内部风险和种族/族裔群体之间参数值的差异。
通过系统报告用于填充模型的证据综合过程，并明确评估输入模型的数据质量，可以通过更好地将建模纳入决策来实现更好的决策。有效沟通这一过程可以帮助确定当地 HIV 预防和护理服务中最具信息性的部分的数据收集优先级，以减少决策不确定性并加强模型结论。
