Past NEEMA Funded Projects by Topic Area – Adolescent and School Health

Men who have sex with men (MSM) experience a very high burden of new and existing HIV infections and sexually transmitted infections. This project specifically focuses on the Adolescent Sexual Minority Male (ASMM) population to create estimates and models of the impact of HIV prevention interventions, particularly HIV pre-exposure prophylaxis (PrEP), among this population. In the first phase, literature searches and data analyses were conducted in order to publish estimates of behavioral and testing parameters for ASMM. In the second phase, agent-based models are being adapted to understand the impact of PrEP-targeting strategies in the ASMM population.

A user-friendly transmission modeling tool will be built to provide answers to the relationship between behavioral changes and direct health outcomes (i.e. incidence and prevalence changes among those engaging in behavioral change, and/or their partners) in the short term. The tool will represent a general adolescent population. Model inputs will include behavioral parameters (e.g. number of sexual acts, number of sexual partners, condom use per act or per partner, proportion having male or female partners), biological parameters (e.g. transmission probabilities by pathogen), and clinical parameters (e.g. rate of treatment and/or recovery from the infection).

Current CDC guidelines calling for routine HIV screening among youth are rarely followed: only 13% had ever been tested for HIV by 2012. This project projected the potential clinical impact, cost, and cost-effectiveness of alternative strategies of HIV screening in youth aged 13-24 years in the US. The Cost-Effectiveness of Preventing AIDS Complications (CEPAC)-US model was used to simulate HIV-uninfected 12-year olds at average-risk, and high-risk for HIV. Annual HIV incidence per 100,000 persons was stratified by age and risk. In addition to current (“background”) US screening practices for average-risk youth (13% ever tested before age 18) and high-risk youth (21% ever tested before age 18), Five HIV screening strategies were modeled: current practice plus an additional test at age 13, 15, 18, 21, or 24. We used published data on HIV disease progression, treatment response, and healthcare costs. Model outcomes included mean CD4 count at diagnosis; proportion of HIV-infected youth diagnosed, linked to care, and retained by age 24 (“HIV cascade” outcomes); life expectancy (LE) and per-person lifetime healthcare costs for the total population and those HIV-infected, and incremental cost-effectiveness ratios in dollars/life-year saved (LYS).

This project evaluates the effectiveness of school-based screening for chlamydia within a variety of community settings. Our analyses are exploring the potential impact of these screening programs by modeling a range of intervention strategies in urban settings characterized by varying profiles and pre-existing levels of chlamydia screening in public high schools. Three urban school-based chlamydia screening programs will help to provide a strong empirical basis for modeling specific programs and associated outcomes. Work is currently ongoing with these program sites to review program implementation, data availability and data access. The model will incorporate the data and profile of each of participating site, and will accommodate replication of existing programs as well as generalization to enable exploration of potential outcomes under a wide range of different circumstances reflecting variation in epidemiology and existing health services coverage.

This project is involves conducting two systematic reviews and meta-analyses using Cochrane and GRADE methods, one on school-based interventions for pregnancy prevention and the other on school-based HIV/STI prevention programs.