A Multi-Agent Reinforcement Learning Framework for Evaluating the U.S. Ending the HIV Epidemic Plan

Human immunodeficiency virus (HIV) is a major public health concern in the United States, with about 1.2 million people living with HIV and 35,000 newly infected each year. There are considerable geographical disparities in HIV burden and care access across the U.S. The 2019 Ending the HIV Epidemic (EHE) initiative aims to reduce new infections by 90% by 2030, by improving coverage of diagnoses, treatment, and prevention interventions and prioritizing jurisdictions with high HIV prevalence. Identifying optimal scale-up of intervention combinations will help inform resource allocation. Existing HIV decision analytic models either evaluate specific cities or the overall national population, thus overlooking jurisdictional interactions or differences. In this paper, we propose a multi-agent reinforcement learning (MARL) model, that enables jurisdiction-specific decision analyses but in an environment with cross-jurisdictional epidemiological interactions. In experimental analyses, conducted on jurisdictions within California and Florida, optimal policies from MARL were significantly different than those generated from single-agent RL, highlighting the influence of jurisdictional variations and interactions. By using comprehensive modeling of HIV and formulations of state space, action space, and reward functions, this work helps demonstrate the strengths and applicability of MARL for informing public health policies, and provides a framework for expanding to the national-level to inform the EHE.