Model-Based Methods to Translate Adolescent Medicine Trials Network for HIV/AIDS Interventions Findings Into Policy Recommendations: Rationale and Protocol for a Modeling Core (ATN 161)

Abstract
Background: The Centers for Disease Control and Prevention (CDC) estimates that approximately 60,000 youth in the United States are living with HIV. Compared to adults, youth living with HIV (YLWH) face worse health outcomes, including lower rates of diagnosis, care engagement, retention, and viral load suppression. Supported by the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN), new trials are underway to test youth-focused interventions aimed at improving care retention and medication adherence for YLWH.

Objective: This study aimed to utilize a computer simulation model, the Cost-Effectiveness of Preventing AIDS Complications (CEPAC)-Adolescent Model, to assess the effectiveness of ongoing and upcoming ATN interventions designed to improve viral load suppression in YLWH. The goal was to identify key benchmarks for the uptake, effectiveness, durability, and cost of these interventions, determining what would make them clinically beneficial and cost-effective.

Methods: This protocol, ATN 161, establishes the ATN Modeling Core, which draws upon extensive data collected from prior National Institutes of Health-supported studies. These data will be used to develop innovative modeling approaches for HIV disease progression and care in YLWH. As new data emerges from ongoing ATN trials, the CEPAC-Adolescent simulation model will serve as a dynamic tool to predict the long-term clinical and economic impacts of these interventions. The Modeling Core will develop input parameters and a model structure that reflects key factors in HIV transmission, progression, and treatment in YLWH. The ATN Modeling Core Steering Committee, with input from ATN leadership and scientific experts, will prioritize analyses, guide the development of model parameters, and offer feedback. Research teams will help refine research questions, provide input on model parameters, and interpret results, including sensitivity analyses and policy recommendations.

Results: Funding for this project was secured in September 2017.

Conclusions: The ATN Modeling Core will provide ATN-161 essential insights to inform the expansion of ATN interventions and guide the translation of findings into policy recommendations for YLWH in the United States.