Overview
To ensure the fidelity of estimated parameters and mathematical functions in PEARL, we compared individual fits between projected outcomes (such as age distribution, CD4 count, prevalence of risk factors and comorbidities) from simulation data and corresponding data from NAACCORD (“in-sample” approach) among ART-users in 2009 and among the ART-initiators from 2010–2022.
Furthermore, to ensure the fidelity of model projections, we compared the projected age distribution and prevalence of comorbidities of ART-users in PEARL to the observed data from NA-ACCORD from 2010-2022 that they’re not directly used to inform the model (“out-of-sample” approach).
To account for outliers, we present the median value across 200 simulations. Agents and NAACCORD members that initate ART or reengage are included in calculations for that given year. Likewise, agents and members that disengage or die are also counted in that given year.
Initial Population in Year 2009
Age Distribution of Initial Population in Year 2009
The age distribution of the simulated population on ART in year 2009 is shown, modeled via a two-component mixed normal distribution (black line) based on data from NA-ACCORD (blue bars).
Figure 1a: HET Black Female
Figure 1b: HET White Female
Figure 1c: HET Hispanic Female
Figure 1d: HET Black Male
Figure 1e: HET White Male
Figure 1f: HET Hispanic Male
Figure 1g: IDU Black Female
Figure 1h: IDU White Female
Figure 1i: IDU Hispanic Female
Figure 1j: IDU Black Male
Figure 1k: IDU White Male
Figure 1l: IDU Hispanic Male
Figure 1m: Black MSM
Figure 1n: White MSM
Figure 1o: Hispanic MSM
CD4 Count Distribution at ART Initiation of Initial Population in Year 2009
The CD4 count distribution of the simulated population on ART in year 2009 is shown. The black line represents the simulated CD4 count values against NA-ACCORD data (blue bars). CD4 count is drawn from a normal distribution with parameters fit to a linear function of ART initiation year.
Figure 2a: HET Black Female
Figure 2b: HET White Female
Figure 2c: HET Hispanic Female
Figure 2d: HET Black Male
Figure 2e: HET White Male
Figure 2f: HET Hispanic Male
Figure 2g: IDU Black Female
Figure 2h: IDU White Female
Figure 2i: IDU Hispanic Female
Figure 2j: IDU Black Male
Figure 2k: IDU White Male
Figure 2l: IDU Hispanic Male
Figure 2m: Black MSM
Figure 2n: White MSM
Figure 2o: Hispanic MSM
Population Initiating ART from 2010 - 2022
Age Distribution of ART Initiators
The age distribution of the simulated population initiating ART from 2010 - 2022 is shown. The black line represents the simulated age distribution against NA-ACCORD data (blue bars). Age at ART initiation is modeled by a two-component mixed normal distribution with parameters fit to a linear function of ART initiation year.
Figure 3a: HET Black Female
Figure 3b: HET White Female
Figure 3c: HET Hispanic Female
Figure 3d: HET Black Male
Figure 3e: HET White Male
Figure 3f: HET Hispanic Male
Figure 3g: IDU Black Female
Figure 3h: IDU White Female
Figure 3i: IDU Hispanic Female
Figure 3j: IDU Black Male
Figure 3k: IDU White Male
Figure 3l: IDU Hispanic Male
Figure 3m: Black MSM
Figure 3n: White MSM
Figure 3o: Hispanic MSM
CD4 Distribution of ART Initiators
The CD4 count distribution of the simulated population initiating ART from 2010 - 2022 is shown. The black line represents the simulated CD4 count values against NA-ACCORD data (blue bars). CD4 count is drawn from a normal distribution with parameters fit to a linear function of ART initiation year.
Figure 4a: HET Black Female
Figure 4b: HET White Female
Figure 4c: HET Hispanic Female
Figure 4d: HET Black Male
Figure 4e: HET White Male
Figure 4f: HET Hispanic Male
Figure 4g: IDU Black Female
Figure 4h: IDU White Female
Figure 4i: IDU Hispanic Female
Figure 4j: IDU Black Male
Figure 4k: IDU White Male
Figure 4l: IDU Hispanic Male
Figure 4m: Black MSM
Figure 4n: White MSM
Figure 4o: Hispanic MSM
Population Disengaging from Care
Age Distribution of ART Users Disengaging from ART
The age distribution of the simulated population disengaging from ART from 2010 - 2021 is shown. The black line represents the simulated age distribution against NA-ACCORD data (blue bars). Age at disengagement from ART is an emergent property of the model.
Figure 5a: HET Black Female
Figure 5b: HET White Female
Figure 5c: HET Hispanic Female
Figure 5d: HET Black Male
Figure 5e: HET White Male
Figure 5f: HET Hispanic Male
Figure 5g: IDU Black Female
Figure 5h: IDU White Female
Figure 5i: IDU Hispanic Female
Figure 5j: IDU Black Male
Figure 5k: IDU White Male
Figure 5l: IDU Hispanic Male
Figure 5m: Black MSM
Figure 5n: White MSM
Figure 5o: Hispanic MSM
CD4 Count Distribution of ART Users Disengaging from ART
The cd4 distribution of the simulated population disengaging from ART from 2010 - 2021 is shown. The black line represents the simulated cd4 distribution against NA-ACCORD data (blue bars). cd4 at disengagement from ART is an emergent property of the model.
Figure 6a: HET Black Female
Figure 6b: HET White Female
Figure 6c: HET Hispanic Female
Figure 6d: HET Black Male
Figure 6e: HET White Male
Figure 6f: HET Hispanic Male
Figure 6g: IDU Black Female
Figure 6h: IDU White Female
Figure 6i: IDU Hispanic Female
Figure 6j: IDU Black Male
Figure 6k: IDU White Male
Figure 6l: IDU Hispanic Male
Figure 6m: Black MSM
Figure 6n: White MSM
Figure 6o: Hispanic MSM
ART Users
Mortality Rate of ART Users
The mortality rate of the simulated population using ART from 2010 - 2020 is shown. The blue line represents the simulated mortality rate against NA-ACCORD data (black dots). Mortality rate is an emergent property of the model.
Figure 7a: HET Black Female
Figure 7b: HET White Female
Figure 7c: HET Hispanic Female
Figure 7d: HET Black Male
Figure 7e: HET White Male
Figure 7f: HET Hispanic Male
Figure 7g: IDU Black Female
Figure 7h: IDU White Female
Figure 7i: IDU Hispanic Female
Figure 7j: IDU Black Male
Figure 7k: IDU White Male
Figure 7l: IDU Hispanic Male
Figure 7m: Black MSM
Figure 7n: White MSM
Figure 7o: Hispanic MSM
Collapsed Mortality Rates
Due to limitations in subgroup sample size, some groups were combined for final analysis. The collapsed group mortality rates are shown below:
Figure 8p: HET White Female + Het Hisp Female
Figure 8q: HET White Male + HET Hisp Male
Figure 8r: IDU Female
Figure 8s: IDU White Male + IDU Hisp Male
Figure 8t: White MSM + Hisp MSM
Age Distribution of ART Users
The age distribution of the simulated population using ART from 2010 - 2017 is shown. The black line represents the simulated age distribution against NA-ACCORD data (blue bars). Age distribution of ART users is an emergent property of the model.
Figure 9a: Black HET Female
Figure 9b: Black HET Male
Figure 9c: Hispanic HET Female
Figure 9d: Hispanic HET Male
Figure 9e: White HET Female
Figure 9f: White HET Male
Figure 9g: Black IDU Female
Figure 9h: Black IDU Male
Figure 9i: Hispanic IDU Female
Figure 9j: Hispanic IDU Male
Figure 9k: White IDU Female
Figure 9l: White IDU Male
Figure 9m: Black MSM
Figure 9n: Hispanic MSM
Figure 9o: White MSM
CD4 Count Distribution of ART Users
The cd4 count distribution of the simulated population using ART from 2010 - 2017 is shown. The black line represents the simulated cd4 count distribution against NA-ACCORD data (blue bars). CD4 count distribution of ART users is an emergent property of the model.
Figure 10a: Black HET Female
Figure 10b: Black HET Male
Figure 10c: Hispanic HET Female
Figure 10d: Hispanic HET Male
Figure 10e: White HET Female
Figure 10f: White HET Male
Figure 10g: Black IDU Female
Figure 10h: Black IDU Male
Figure 10i: Hispanic IDU Female
Figure 10j: Hispanic IDU Male
Figure 10k: White IDU Female
Figure 10l: White IDU Male
Figure 10m: Black MSM
Figure 10n: Hispanic MSM
Figure 10o: White MSM
Population Reengaging from Care
Reengagement with HIV Care
The number of years spent out of care following disengagement for the simulated population is modeling by a normalized Poisson distribution. The probability of spending a certain number of years out of care was fit such that the probability of staying disengaged for more than 12 years was zero. The resulting fit is shown below with the blue line representing the probability of being assigned a number of years out of care and the black dots represented the observed NAACCORD data.
Figure 11: Number of Years Spent Out of Care
CD4 at Reengagement
The distribution of CD4 count at reengagement of the simulated population using ART from 2011 - 2021 is shown. The black line represents the simulated CD4 count distribution against NA-ACCORD data (blue bars). CD4 Count distribution of ART users is an emergent property of the model.
Figure 12a: Black HET Female
Figure 12b: Black HET Male
Figure 12c: Hispanic HET Female
Figure 12d: Hispanic HET Male
Figure 12e: White HET Female
Figure 12f: White HET Male
Figure 12g: Black IDU Female
Figure 12h: Black IDU Male
Figure 12i: Hispanic IDU Female
Figure 12j: Hispanic IDU Male
Figure 12k: White IDU Female
Figure 12l: White IDU Male
Figure 12m: Black MSM
Figure 12n: Hispanic MSM
Figure 12o: White MSM
Comorbidities
The PEARL model allows for subgroups specific projection of future comorbidity burden. To ensure that our model aligns with real-world data, we compare the comorbidity incidence, prevalence, and prevalence at initiation of ART users across all modeled comorbidities.
Incidence
Below we present the incidence comparison of ART users between simulated comorbidities from the PEARL model and comorbity data from the NAACCORD. For each comorbidity plot, we show all subgroups and their alignment with acceptable deviation defined by the maximum of 95% confidence interval and 0.05 absolute value. The fit is defined as the number of years that fall within acceptable deviation and is listed below the subgroup title for each plot. Subgroups that have more than 25% of years outside deviation are shaded red. Due to sample size constraints, some groups are combined in the PEARL model. In these cases, the individual subgroup plots are presented in addition to the combined subgroup plots. The rules for collapsing are shown in the legend to the right.
Figure 13a: Anxiety
Figure 13b: Chronic Kidney Disease
Figure 13c: Diabetes
Figure 13d: Depression
Figure 13e: ESLD
Figure 13f: Hypertension
Figure 13g: Hypolipidemia
Figure 13h: Cancer
Figure 13i: MI
Prevalence
Below we present the prevalence comparison of ART users between simulated comorbidities from the PEARL model and comorbity data from the NAACCORD. For each comorbidity plot, we show all subgroups and their alignment with acceptable deviation defined by the maximum of 95% confidence interval and 0.05 absolute value. The fit is defined as the number of years that fall within acceptable deviation and is listed below the subgroup title for each plot. Subgroups that have more than 25% of years outside deviation are shaded red. Due to sample size constraints, some groups are combined in the PEARL model. In these cases, the individual subgroup plots are presented in addition to the combined subgroup plots. The rules for collapsing are shown in the legend to the right.
Figure 14a: Anxiety
Figure 14b: Chronic Kidney Disease
Figure 14c: Diabetes
Figure 14d: Depression
Figure 14e: ESLD
Figure 14f: Hypertension
Figure 14g: Hypolipidemia
Figure 14h: Cancer
Figure 14i: MI
Prevalence at ART Initiation
Below we present the prevalence comparison of ART users at initiation between simulated comorbidities from the PEARL model and comorbity data from the NAACCORD. For each comorbidity plot, we show all subgroups and their alignment with acceptable deviation defined by the maximum of 95% confidence interval and 0.05 absolute value. The fit is defined as the number of years that fall within acceptable deviation and is listed below the subgroup title for each plot. Subgroups that have more than 25% of years outside deviation are shaded red. Due to sample size constraints, some groups are combined in the PEARL model. In these cases, the individual subgroup plots are presented in addition to the combined subgroup plots. The rules for collapsing are shown in the legend to the right.
Figure 15a: Anxiety
Figure 15b: Chronic Kidney Disease
Figure 15c: Diabetes
Figure 15d: Depression
Figure 15e: ESLD
Figure 15f: Hypertension
Figure 15g: Hypolipidemia
Figure 15h: Cancer
Figure 15i: MI
