Simulation Modeling and Metamodeling to Inform National and International HIV Policies for Children and Adolescents.

Andrea Ciaranello,Elaine J Abrams,Mary Mahy,Intira Jeannie Collins,Claire Rothery,Pamela Pei,Martina Penazzato,Beth Woods,Annette H Sohn

doi:10.1097/qai.0000000000001749

Abstract

Objective and Approach:Computer-based simulation models serve an important purpose in informing HIV care for children and adolescents. We review current model-based approaches to informing pediatric and adolescent HIV estimates and guidelines.Findings:Clinical disease simulation models and epidemiologic models are used to inform global and regional estimates of numbers of children and adolescents living with HIV and in need of antiretroviral therapy, to develop normative guidelines addressing strategies for diagnosis and treatment of HIV in children, and to forecast future need for pediatric and adolescent antiretroviral therapy formulations and commodities. To improve current model-generated estimates and policy recommendations, better country-level and regional-level data are needed about children living with HIV, as are improved data about survival and treatment outcomes for children with perinatal HIV infection as they age into adolescence and adulthood. In addition, novel metamodeling and value of information methods are being developed to improve the transparency of model methods and results, as well as to allow users to more easily tailor model-based analyses to their own settings.Conclusions:Substantial progress has been made in using models to estimate the size of the pediatric and adolescent HIV epidemic, to inform the development of guidelines for children and adolescents affected by HIV, and to support targeted implementation of policy recommendations to maximize impact. Ongoing work will address key limitations and further improve these model-based projections.

Highlights

Computer-based simulation models serve several critical roles in informing HIV-related policies for children and adolescents
Substantial progress has been made in using models to estimate the size of the pediatric and adolescent HIV epidemic, to inform the development of guidelines for children and adolescents affected by HIV, and to support targeted implementation of policy recommendations to maximize impact
Clinical disease simulation models focus on important events that occur in individual patients; they capture details of HIV disease progression, care engagement and retention, and treatment outcomes, as well as their associated costs

Summary

Introduction

Computer-based simulation models serve several critical roles in informing HIV-related policies for children and adolescents. Epidemiologic models focus on the impact of HIV on populations, including at the national and global levels These models often capture clinical outcomes as well, and can be used to examine the impact of specific HIV-related interventions, but they can provide estimates of numbers of new infections, people living with HIV, people in need of and receiving ART, and deaths due to HIV. Both types of models offer insight into HIV policies in 5 key ways They allow investigators to combine the best available data from multiple sources when no single source provides sufficient information: for example, clinical trial data to inform ART response, cohort data to inform disease progression risks, and epidemiologic and program data to inform numbers of children on ART. They permit comparisons of multiple alternative strategies, even when no

Methods

Results

Conclusion