The Health and Economic Forecasting Micro-Simulation Model: A tool to evaluate future health policies and programmatic interventions targeting the aging population living with HIV in British Columbia

In high-income settings such as Canada, the United States, and the European Union, HIV infection is increasingly being managed as a chronic disease. Notably, people living in these settings now expect to live as long as their non HIV-infected counterparts. Marked reductions in AIDS-related deaths are, in part, due to the increasingly widespread use of antiretroviral treatment for HIV. However, premature morbidity and mortality from non-AIDS related causes are on the rise, and have been associated with accelerated aging of people living with HIV/AIDS (PLWH), as well as life-style characteristics, socio-economic constraints, and inadequate engagement in care. In this 5-year study, we will develop and use a new methodology to evaluate and forecast the impact of ongoing and emerging policies and programs for the prevention of HIV transmission and control of disease progression targeting PLWH in British Columbia (BC). Importantly, we will also use these methods to predict the incidence and prevalence of comorbidities amongst PLWH in BC. This will provide highly relevant new information for decision makers as they formulate plans to address future impact of HIV disease and comorbidities, and utilization of healthcare resources by an aging population. Our proposed study accounts for the role of key factors affecting mortality and morbidity in the population living with HIV/AIDS, including demographic (e.g., age, gender, ethnicity), life-style (e.g., illicit drug and alcohol use, smoking) and treatment-related factors (e.g., type of HIV treatment). Our ability to confidentially link administrative databases with information on all PLWH in BC makes this one of the first interdisciplinary research studies to examine the impact of growing older while living with HIV and comorbid conditions. This information will be applicable in BC, in other jurisdictions across Canada and internationally.