Developing a dynamic HIV transmission model for 6 US cities: An evidence synthesis

• Type of Material: Article
• Authors: Emanuel Krebs, British Columbia Center for Excellence in HIV/AIDS; Benjamin Enns, British Columbia Center for Excellence in HIV/AIDS; Linwei Wang, British Columbia Center for Excellence in HIV/AIDS; Xiao Zang, British Columbia Center for Excellence in HIV/AIDS; Dimitra Panagiotoglou, British Columbia Center for Excellence in HIV/AIDS; Carlos Del Rio, Emory University; Julia Dombrowski, University of Washington; Daniel J. Feaster, University of Miami; Matthew Golden, University of Washington; Reuben Granich, International Association of Providers of AIDS Care; Brandon Marshall, Brown University; Shruti H. Mehta, Johns Hopkins University; Lisa Metsch, Columbia University; Bruce R. Schackman, Weill Cornell Medical College; Steffanie A. Strathdee, University of California San Diego; Bohdan Nosyk, British Columbia Center for Excellence in HIV/AIDS
• Language: English
• Date: 2019-05-30
• Publisher: Public Library of Science
• Publication Version: Final Published Version
• Copyright Statement: © 2019 Krebs et al.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1371/journal.pone.0217559
• Title of Journal or Parent Work: PLoS ONE
• ISSN: 1932-6203
• Volume: 14
• Issue: 5
• Start Page: e0217559
• End Page: e0217559
• Grant/Funding Information: BRS received additional support from the Center for Health Economics of Treatment Interventions for Substance Use Disorder, HCV, and HIV (P30DA040500).; This study was funded by the National Institutes on Drug Abuse (NIDA), grant no. R01-DA041747 (BN), and received additional support from NIDA grants DA12568 and DA036297.; The funders had no direct role in the conduct of the analysis or the decision to submit the manuscript.; SAS is supported by a NIDA Method to Extend Research in Time (MERIT) award (R37-DA019829).
• Keywords: Science & Technology; HUMAN-IMMUNODEFICIENCY-VIRUS; PLASMA VIRAL LOAD; DECISION-ANALYTIC MODELS; Science & Technology - Other Topics; ANTIRETROVIRAL THERAPY; COST-EFFECTIVENESS; QUALITY-OF-LIFE; INJECTING DRUG-USERS; Multidisciplinary Sciences; HETEROSEXUAL TRANSMISSION; HEALTH STATE UTILITIES; ECONOMIC EVALUATIONS
• Research Categories: Biology, Virology; Health Sciences, Immunology; Health Sciences, Public Health

Abstract

Background 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. Methods 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. Findings 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. Conclusions 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.