Cost-effectiveness of cardiovascular disease prevention in HIV care: a systems science approach

艾滋病毒护理中心血管疾病预防的成本效益：系统科学方法

• 批准号: 10219503
• 负责人: Karla Ivette Galaviz
• 金额: $ 12.54万
• 依托单位: TRUSTEES OF INDIANA UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-20 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10219503
• 关键词: Acquired Immunodeficiency Syndrome; Address; Adoption; Age; Aging; American; Behavior; Behavioral; Blood Pressure; Body Composition; Cardiovascular Diseases; Caring; Clinical; Cohort Studies; Collaborations; Communities; Computer Models; Computer Simulation; Costs and Benefits; Counseling; Data; Decision Support Systems; Development; Diet; Disease; Disease Outcome; Engineering; Epidemiology; Event; Face; Future; General Population; Goals; Guidelines; HIV; HIV Seronegativity; Health; Health Care Costs; Incidence; Individual; Inflammation; Infrastructure; Intervention; Intervention Studies; Life Style; Life Style Modification; Mentored Research Scientist Development Award; Methodology; Methods; Mission; Modeling; Motivation; National Heart, Lung, and Blood Institute; Pharmaceutical Preparations; Physical activity; Population; Prevalence; Prevention strategy; Process; Protocols documentation; Public Health Schools; Publishing; Recommendation; Research; Research Design; Research Personnel; Research Priority; Resources; Risk Factors; Running; Sampling; Science; Scientist; Structure; System; Testing; Training; Universities; Validation; Veterans; adjudication; base; blood lipid; cardiometabolism; cardiorespiratory fitness; cardiovascular disorder prevention; cardiovascular disorder risk; career; cohort; comparative cost effectiveness; cost effective; cost effectiveness; cost estimate; economic evaluation; effective intervention; effectiveness trial; evidence base; experience; experimental study; global health; implementation research; implementation strategy; improved; intervention cost; intervention effect; knowledge translation; model development; mortality; multiphase optimization strategy; novel; professor; programs; research to practice; simulation; skills; virtual experiments

PROJECT SUMMARY Implementing effective cardiovascular disease (CVD) prevention strategies is critical for reducing the disproportionately greater burden of adverse CVD outcomes facing people living with HIV. Lifestyle modification has been identified as a first-line CVD prevention strategy for the general population and recommended in HIV clinical guidelines. Yet, evidence-based lifestyle modification interventions such as behavioral counseling and referrals to community resources are rarely used in routine HIV care workflows. Addressing this research-to-practice gap requires understanding what processes and structures are needed for effective intervention delivery in HIV care, estimating the costs of interventions, and identifying leverage points in existing systems to integrate interventions. Agent-based modeling (ABM) is a novel systems science approach that can sort through these intervention and system complexities to find the most cost-effective intervention solutions and delivery paths. Thus, the overall goal of this study is to engineer a cost-effective strategy to integrate lifestyle modification interventions in HIV care using ABM. With guidance from experts in HIV (Dr. Ofotokun), CVD (Dr. Ali), ABM (Dr. Bodner), and economic evaluation (Dr. Rask), this goal will be accomplished through the following specific aims: 1) assess the contributions of traditional and HIV-specific risk factors to CVD development in people living with HIV; 2) develop, calibrate, and validate an exploratory ABM that simulates the cost-effectiveness of implementation strategies focused on integrating lifestyle counseling and referral in HIV care; and 3) engineer an optimized strategy for integrating lifestyle counseling and referral in HIV care using ABM and the Multiphase Optimization Strategy. Leveraging these novel computer modeling and engineering methods will allow us to preemptively model intervention solutions and delivery paths to address research-to-practice gaps in HIV care. I am an Assistant Professor of Global Health in the Rollins School of Public Health at Emory University. I have expertise in health intervention research, knowledge translation and epidemiology and possess the ability, experience, motivation, and determination to successfully complete the proposed training and research plans. This K01 award will equip me with new systems science and economic evaluation skills and broaden my understanding and abilities to effect true change in CVD prevention in the HIV population. Because this application aligns with NHLBI's HIV-CVD research priorities and its strategic mission to optimize implementation research, it represents a strong platform on which to build my career as an independent implementation scientist working at the intersection of cardiometabolic diseases and HIV.

项目概要 实施有效的心血管疾病 (CVD) 预防策略对于减少心血管疾病的发生至关重要 艾滋病毒感染者面临着不成比例的更大的不良心血管疾病结局负担。生活方式 改良已被确定为普通人群的一线 CVD 预防策略， HIV临床指南中推荐。然而，基于证据的生活方式改变干预措施，例如 行为咨询和社区资源转介很少用于常规艾滋病毒护理工作流程中。 解决这一研究与实践之间的差距需要了解需要哪些流程和结构 在艾滋病毒护理中提供有效的干预措施，估计干预措施的成本，并确定杠杆点 在现有系统中整合干预措施。基于代理的建模（ABM）是一门新颖的系统科学 可以对这些干预措施和系统复杂性进行排序，以找到最具成本效益的方法 干预解决方案和实施路径。因此，本研究的总体目标是设计一种具有成本效益的 使用 ABM 将生活方式改变干预措施纳入艾滋病毒护理的策略。在专家的指导下 HIV（Ofotokun博士）、CVD（Ali博士）、ABM（Bodner博士）和经济评估（Rask博士），这个目标将是 通过以下具体目标来实现： 1) 评估传统和艾滋病毒特异性的贡献 艾滋病毒感染者发生心血管疾病的危险因素； 2）开发、校准和验证探索性 ABM 模拟注重整合生活方式的实施策略的成本效益 艾滋病毒护理方面的咨询和转诊； 3) 设计整合生活方式咨询的优化策略 使用 ABM 和多阶段优化策略进行 HIV 护理转诊。利用这些小说 计算机建模和工程方法将使我们能够预先对干预解决方案进行建模， 解决艾滋病毒护理研究与实践差距的交付途径。 我是埃默里大学罗林斯公共卫生学院全球健康助理教授。我 拥有健康干预研究、知识转化和流行病学方面的专业知识，并拥有 成功完成拟议培训和研究的能力、经验、动机和决心 计划。这个 K01 奖项将为我提供新的系统科学和经济评估技能，并拓宽我的视野 理解并有能力在艾滋病毒人群中实现心血管疾病预防方面的真正改变。因为这个 该应用程序符合 NHLBI 的 HIV-CVD 研究重点及其优化战略使命 实施研究，它代表了一个强大的平台，我可以在此基础上建立独立的职业生涯 从事心脏代谢疾病和艾滋病毒交叉领域工作的实施科学家。