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Obtaining population-based estimates of the timing of antiretroviral therapy initiation using HIV surveillance data: Change-point model development, validation, and dissemination

Award Number: R21AI147933
ORGANIZATION: NATIONAL INSTITUTE OF ALLERGY & INFECTIOUS DISEASES
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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PROJECT SUMMARY/ABSTRACT The primary goal of public health efforts which aim to control HIV epidemics in the United States and around the world is to diagnose and treat people with HIV infection as soon as possible after seroconversion. The timing of the first antiretroviral therapy (ART) treatment after HIV diagnosis is therefore an important population-level indicator that can be used to measure the effectiveness of HIV care programs and policies at local and national levels. However, there are no population-based estimates of the timeliness of ART initiation in the US because data on the timing of ART initiation cannot feasibly and efficiently be collected as part of routine jurisdictional HIV surveillance activities. In this project, we propose to develop a statistical model for the estimation of the timing of ART initiation following HIV diagnosis. We will use routinely collected, population-based data on laboratory tests from all persons diagnosed with HIV infection, including biomarkers such as viral load (VL) and CD4 count, from the New York City (NYC) Department of Health and Mental Hygiene (DOHMH). We will develop a change- point model in which the VL and CD4 counts are jointly modeled, where the ART initiation time is treated as a random change point that induces simultaneous trajectory changes to the biological process of both VL and CD4 counts. Several data complexities challenge the model development. First, variability in CD4 count or VL monitoring by providers leads to imbalanced VL and CD4 count reporting times at the individual level. Second, the instrument detection limit leads to data censoring for VL. Third, the study population is heterogeneous, such that some individuals start ART right after the diagnosis (test and treat), while others delay treatment (delay treatment) or remain untreated (no treatment). We will develop statistical methods to address these data complications. The methodology will be built upon likelihood and approximated-likelihood inferences coupled with missing data handling and mixture population modeling. Leveraging ART prescription information from Medicaid claims data linked at the individual level to the HIV surveillance data, we will cross-validate our model- based estimations and refine the modeling. Finally, we will disseminate a free R package to share the methods and the toolset with researchers. Following the completion of this project, we hope to substantially improve the ability to obtain reliable population-based estimates on the timing of ART initiation for people living with HIV. We expect the methods and the toolset will be used to inform policies and programs in NYC and other jurisdictions and will help these jurisdictions improve access to HIV prevention and treatment services and facilitate initiatives to better control HIV epidemics.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2023 ( Subtotal = $0 )
2023	2021	RESEARCH FOUNDATION OF THE CITY UNIVERSITY OF NEW YORK	55 WEST 125TH ST FL 7	NEW YORK	NY	10027	NEW YORK	USA	Allergy and Infectious Diseases Research	000	2	2/21/2023	NON-COMPETING CONTINUATION	$0
														Subtotal = $0

Issue Date FY: 2022 ( Subtotal = $0 )
2022	2021	RESEARCH FOUNDATION OF THE CITY UNIVERSITY OF NEW YORK	55 WEST 125TH ST FL 7	NEW YORK	NY	10027	NEW YORK	USA	Allergy and Infectious Diseases Research	001	2	9/13/2022	NON-COMPETING CONTINUATION	$0
2022	2021	RESEARCH FOUNDATION OF THE CITY UNIVERSITY OF NEW YORK	55 WEST 125TH ST FL 7	NEW YORK	NY	10027	NEW YORK	USA	Allergy and Infectious Diseases Research	000	2	4/8/2022	NON-COMPETING CONTINUATION	$0
														Subtotal = $0

Issue Date FY: 2021 ( Subtotal = $202,974 )
2021	2021	RESEARCH FOUNDATION OF THE CITY UNIVERSITY OF NEW YORK	55 WEST 125TH ST FL 7	NEW YORK	NY	10027	NEW YORK	USA	Allergy and Infectious Diseases Research	000	2	1/29/2021	NON-COMPETING CONTINUATION	$202,974
														Subtotal = $202,974

Issue Date FY: 2020 ( Subtotal = $243,230 )
2020	2020	RESEARCH FOUNDATION OF THE CITY UNIVERSITY OF NEW YORK	55 WEST 125TH ST FL 7	NEW YORK	NY	10027	NEW YORK	USA	Allergy and Infectious Diseases Research	000	1	2/6/2020	NEW	$243,230
														Subtotal = $243,230

Grand Total All Awards = $446,204

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Obtaining population-based estimates of the timing of antiretroviral therapy initiation using HIV surveillance data: Change-point model development, validation, and dissemination

Award Number: R21AI147933

ORGANIZATION: NATIONAL INSTITUTE OF ALLERGY & INFECTIOUS DISEASES

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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