Martin Erika G, MacDonald Roderick H, Gordon Daniel E, Swain Carol-Ann, O'Donnell Travis, Helmeset John, Dwicaksono Adenantera, Tesoriero James M
1084 Department of Public Administration and Policy, University at Albany, Albany, NY, USA.
Center for Collaborative HIV Research in Practice and Policy, Albany, NY, USA.
Public Health Rep. 2020 Jul/Aug;135(1_suppl):158S-171S. doi: 10.1177/0033354920935069.
In 2014, the governor of New York announced the Ending the Epidemic (ETE) plan to reduce annual new HIV infections from 3000 to 750, achieve a first-ever decrease in HIV prevalence, and reduce AIDS progression by the end of 2020. The state health department undertook participatory simulation modeling to develop a baseline for comparing epidemic trends and feedback on ETE strategies.
A dynamic compartmental model projected the individual and combined effects of 3 ETE initiatives: enhanced linkage to and retention in HIV treatment, increased preexposure prophylaxis (PrEP) among men who have sex with men, and expanded housing assistance. Data inputs for model calibration and low-, medium-, and high-implementation scenarios (stakeholders' rollout predictions, and lower and upper bounds) came from surveillance and program data through 2014, the literature, and expert judgment.
Without ETE (baseline scenario), new HIV infections would decline but remain >750, and HIV prevalence would continue to increase by 2020. Concurrently implementing the 3 programs would lower annual new HIV infections by 16.0%, 28.1%, and 45.7% compared with baseline in the low-, medium-, and high-implementation scenarios, respectively. In all concurrent implementation scenarios, although annual new HIV infections would remain >750, there would be fewer new HIV infections than deaths, yielding the first-ever decrease in HIV prevalence. PrEP and enhanced linkage and retention would confer the largest population-level changes.
New York State will achieve 1 ETE benchmark under the most realistic (medium) implementation scenario. Findings facilitated framing of ETE goals and underscored the need to prioritize men who have sex with men and maintain ETE's multipronged approach, including other programs not modeled here.
2014年，纽约州州长宣布了“终结疫情”（ETE）计划，目标是将每年新增艾滋病毒感染病例从3000例减少至750例，首次降低艾滋病毒流行率，并在2020年底前减少艾滋病进展。该州卫生部门开展了参与式模拟建模，以制定一个基线，用于比较疫情趋势并为ETE策略提供反馈。
一个动态 compartmental 模型预测了3项ETE举措的个体和综合效果：加强艾滋病毒治疗的联系和留存、增加男男性行为者的暴露前预防（PrEP）以及扩大住房援助。模型校准和低、中、高实施情景（利益相关者的推出预测以及下限和上限）的数据输入来自2014年的监测和项目数据、文献以及专家判断。
若无ETE（基线情景），新增艾滋病毒感染病例将会下降，但到2020年仍将超过750例，艾滋病毒流行率将继续上升。与基线相比，在低、中、高实施情景下同时实施这3项计划，每年新增艾滋病毒感染病例将分别降低16.0%、28.1%和45.7%。在所有同时实施情景中，尽管每年新增艾滋病毒感染病例仍将超过750例，但新增艾滋病毒感染病例将少于死亡病例，从而首次降低艾滋病毒流行率。PrEP以及加强联系和留存将带来最大的人群层面变化。
在最现实的（中等）实施情景下，纽约州将实现1个ETE基准。研究结果有助于确定ETE目标，并强调需要将男男性行为者作为优先重点，维持ETE的多管齐下方法，包括此处未建模的其他项目。
