Could long-acting medications facilitate "ending AIDS by 2030" in southern Africa? An allocative efficiency analysis

长效药物能否促进南部非洲“到 2030 年终结艾滋病”？

• 批准号: 10228020
• 负责人: Ronald Scott Braithwaite
• 金额: $ 70.27万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-25 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10228020
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Adherence; Appointment; Arts; Budgets; Caring; Collaborations; Computer Simulation; Continuity of Patient Care; Cost Effectiveness Analysis; Country; Data; Decision Making; Epidemic; Formulation; Funding; Goals; HIV; Health; Health Benefit; Incidence; Individual; Inequality; Infrastructure; Intervention; Link; Male Circumcision; Medical; Mental disorders; Modeling; Morbidity - disease rate; Operations Research; Pharmaceutical Preparations; Policies; Population; Prevention strategy; Preventive; Province; Published Comment; Publishing; Randomized Controlled Trials; Recording of previous events; Resource Allocation; Resources; Role; South Africa; Southern Africa; Swaziland; Text; Viral; Viral Load result; Zimbabwe; alcohol use disorder; antiretroviral therapy; base; cost; cost effective; demographics; financial incentive; high risk population; improved; intervention cost; mathematical model; medication compliance; mortality; phase III trial; pre-exposure prophylaxis; surveillance data; tool

ABSTRACT/SUMMARY In our 2018 Lancet HIV commentary (“Ending AIDS by 2030: Catchy slogan or sincere goal?"), we note that published surveillance data together with mathematical modeling make it clear that UNAIDS 2030 goals (90% reduction in HIV incidence) are not going to be met with current spending and resource allocation, and UNAIDS 2020 goals (90% of infected are detected, 90% of detected are linked to care, and 90% of linked to care are virally suppressed) are not going to be met by 2020. Existing models suggest a tripling in HIV spending (from $12.8 billion to $40 billion per year) would be necessary to meet these goals, together with an optimizing of that spending. Indeed, without optimization, the necessary spending for that goal would likely top $52 billion per year. To achieve UNAIDS 2030 goals it will be necessary to critically assess the role of all available tools and tailor strategies to maximize their impact. However, current mathematical models omit three important tools in the arsenal for achieving 2030 goals in resource-limited regions: (1) Specific interventions that target the HIV care continuum (in particular specific interventions with randomized controlled-trial evidence include SMS-based text reminders for appointments and/or medications and combination interventions similar to Link4Health [including accelerated medication initiation, SMS-based text reminders, care/information package +/- noncash financial incentive]), (2) targeting interventions to high risk populations (such as those with alcohol use disorders [AUDs] and common mental disorders [CMDs]) that are specifically relevant to a region’s demographics and policy constraints, and (3) alternate timing of the peak of HIV spending (earlier is better because it leads to “getting ahead of the epidemic” but may be less feasible). Accordingly, focusing on the countries of Zimbabwe, eSwatini (formerly known as Swaziland), and South Africa (in particular, the province of KwaZulu Natal [KZN]) because of their disproportionate burden of HIV morbidity and mortality, our proposal uses mathematical modeling to evaluate the allocative efficiency of a wide spectrum of combination HIV prevention strategies to determine: How cost-effective would interventions enhancing ART linkage-adherence-retention (e.g., long acting ART) need to be in order to efficiently constitute combination HIV prevention strategy (Aim 1); How cost-effective would interventions enhancing PrEP linkage- adherence-retention (e.g., long-acting PrEP) need to be in order to efficiently constitute combination HIV prevention strategy (Aim 2); and how cost-effective would interventions enhancing PrEP and ART linkage- adherence-retention need to be in order to efficiently constitute combination HIV prevention strategy (Aim 3).

摘要/摘要 在我们的2018年柳叶刀艾滋病毒评论（“到2030年结束艾滋病：引人入胜的口号或真诚的目标？”），我们注意到这一点 已发布的监视数据以及数学建模清楚地表明，UNAID 2030目标（90％ 减少艾滋病毒事件）不会通过当前的支出和资源分配来满足 UNAIDS 2020目标（检测到90％的感染，90％的检测到与护理有关 几乎被抑制了护理）到2020年将无法满足。现有模型表明艾滋病毒三倍 满足这些目标是必要的支出（每年128亿美元至400亿美元） 优化该支出。确实，如果没有优化，该目标的必要支出可能会达到顶峰 每年520亿美元。 为了实现UNAIDS 2030目标，有必要批判性地评估所有可用工具的作用和裁缝 最大化其影响的策略。但是，当前的数学模型省略了三个重要工具 阿森纳在资源有限的地区实现2030个目标：（1）针对艾滋病毒护理的特定干预措施 连续体（特别是具有随机控制证据的特定干预措施包括基于SMS 与Link4Health类似的约会和/或药物的预约和/或组合干预措施的提醒 [包括加速药物计划，基于SMS的文本提醒，Care/Information Package +/- NONCASH ]），（2）针对高风险人群的干预措施（例如饮酒的人群 疾病[AUDS]和常见的精神障碍[CMDS]）与地区特别相关 人口统计和政策限制，以及（3）艾滋病毒支出高峰的替代时机（早期更好 因为它导致“领先于流行病”，但可能不太可行）。 根据津巴布韦，埃斯瓦蒂尼（以前称为斯威士兰）和南非的国家 （尤其是夸祖鲁·纳塔尔（Kwazulu Natal 和死亡率，我们的建议使用数学建模来评估广泛的分配效率 组合艾滋病毒预防策略以确定：采取成本效益的干预措施 为了有效地构成 联合艾滋病毒预防策略（AIM 1）；干预措施将如何增强准备链接的成本效益 - 为了有效地构成HIV的依从性 - 依从性（例如，长效准备） 预防策略（目标2）；以及如何提高干预措施来增强准备和艺术联系 - 为了有效地构成预防艾滋病毒的策略（AIM 3）。