Innovation across the spectrum of pediatric HIV care

儿科艾滋病毒护理领域的创新

• 批准号: 10426168
• 负责人: Andrea Lynne Ciaranello
• 金额: $ 67.81万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-07-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10426168
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Address; Adolescence; Adult; Affect; Age; Anti-Retroviral Agents; Award; Benchmarking; Biological Assay; Budgets; Caring; Child; Child Health; Child Mortality; Childhood; Clinical; Clinical Research; Collaborations; Computer Models; Computers; Cost Effectiveness Analysis; Country; Data; Diagnosis; Diagnostic tests; Drug Formulations; Early Diagnosis; Emergency Situation; Ensure; Epidemiology; Event; Formulation; Geography; Goals; Guidelines; HIV; HIV diagnosis; Health; Health Care Costs; Health care facility; Healthcare; Infant; Infant Mortality; Integrase; International; Ivory Coast; Link; Location; Mathematics; Methods; Mission; Modeling; Morbidity - disease rate; National Institute of Child Health and Human Development; Online Systems; Outcome; Paper; Perinatal; Pharmaceutical Preparations; Policies; Policy Analysis; Population; Publishing; Regimen; Research; Research Support; Resources; Role; Site; Source; South Africa; Technology; Tenofovir; Testing; Time; Translating; United States National Institutes of Health; Weight; Woman; Work; World Health Organization; Zimbabwe; antiretroviral therapy; base; clinical practice; cohort; cost; cost effective; cost effectiveness; diagnostic platform; diagnostic technologies; economic value; feeding; improved; improved outcome; individual patient; infant infection; inhibitor; innovation; mortality; multidisciplinary; new technology; novel; novel diagnostics; pediatric human immunodeficiency virus; pediatric human immunodeficiency virus infection; point of care; point-of-care diagnostics; prevent; programs; scale up; tool; uptake

Project Summary The past decade has witnessed remarkable progress in the scale-up of antiretroviral therapy (ART), yet access to optimal diagnosis, care, and treatment remains limited for many of the 2.1 million children living with perinatally-acquired HIV worldwide. Novel diagnostic technologies and antiretroviral drugs (ARVs) can address this treatment gap. Critical questions remain, however, about the most effective way to utilize these innovations for children in settings with very limited resources. For example, how should programs best introduce new point-of-care assays for infant HIV diagnosis, and what are the most effective and cost-effective approaches to roll out pediatric dolutegravir and other emerging ARVs? Where long-term data are limited, or traditional clinical studies are not feasible, computer-based microsimulation modeling can use existing data to inform decisions about how to achieve the best outcomes for children with HIV under constrained healthcare budgets. With NICHD R01 support (2014-2019), we developed the Cost-effectiveness of Preventing AIDS Complications (CEPAC)-Pediatric microsimulation model and have informed guidelines and decisions from the World Health Organization (WHO), the President's Emergency Plan for AIDS Relief (PEPFAR), and country Ministries of Health (MOHs). In the first 4 years of the initial award cycle, we have used microsimulation and cost- effectiveness analysis methods to publish 17 papers related to pediatric HIV prevention, diagnosis, and treatment. We now propose to broaden the scope of this work, expanding a multidisciplinary team with diverse expertise in pediatric HIV care, research, clinical policy, and cost-effectiveness, and adding Zimbabwe to the original focus countries of Côte d'Ivoire and South Africa. This will allow us to compare findings across three PEPFAR settings that encompass a wide and representative range of pediatric HIV epidemiology, clinical practice, and healthcare costs. We will also develop new model-based methods, including location-optimization models and regression-based metamodels that can be used by local program planners to examine emerging care and treatment approaches across the spectrum of pediatric HIV care. We propose two new specific aims: 1. To project the optimal placement and value of innovative diagnostic technologies for pediatric HIV, including point-of-care assays for infant HIV diagnosis. 2. To evaluate the most effective and cost-effective ways to implement new ARV guidelines and introduce new ARV formulations for children, including the planned rollout of dolutegravir. The goal of this proposal is to help clinicians, program planners, and policymakers at MOHs, WHO, and PEPFAR identify the optimal use of scarce resources to improve long-term health for children with HIV. Continuation and expansion of support for the CEPAC-Pediatric modeling program will allow us to develop and disseminate novel modeling methods and address critical, context-specific questions about how to make the best use of innovative new technologies and treatments for millions of children affected by HIV worldwide.

项目摘要 过去十年，在扩大抗逆转录病毒疗法方面取得了显著进展， 最佳诊断，护理和治疗对于210万儿童中的许多人来说仍然有限。 艾滋病病毒感染者。新的诊断技术和抗逆转录病毒药物可以解决 这种待遇差距。然而，关于如何最有效地利用这些创新， 在资源非常有限的环境中为儿童提供服务。例如，程序应该如何最好地引入新的 婴儿艾滋病毒诊断的护理点检测，以及最有效和最具成本效益的方法是什么， 推出儿童dolutegravir和其他新兴的抗逆转录病毒药物？如果长期数据有限，或传统的临床 研究是不可行的，基于计算机的微观模拟建模可以使用现有的数据来告知决策 如何在有限的医疗预算下为艾滋病毒感染儿童取得最佳成果。与 NICHD R 01支持（2014-2019），我们制定了预防艾滋病并发症的成本效益 （CEPAC）-儿科微观模拟模型，并已告知世界卫生组织的指导方针和决定 联合国卫生组织（世卫组织）、总统艾滋病紧急救援计划（PEPFAR）和国家卫生部 卫生部。在最初的奖励周期的前4年，我们使用了微观模拟和成本- 有效性分析方法发表了17篇与儿科艾滋病预防、诊断和 治疗我们现在建议扩大这项工作的范围，扩大一个多学科的团队， 在儿科艾滋病护理，研究，临床政策和成本效益方面的专业知识，并将津巴布韦加入 科特迪瓦和南非是最初的重点国家。这将使我们能够比较三个方面的发现， PEPFAR设置，包括广泛和有代表性的儿科艾滋病毒流行病学，临床 实践和医疗费用。我们还将开发新的基于模型的方法，包括位置优化 模型和基于回归的元模型，可供当地规划人员使用，以检查新兴的 在儿科艾滋病护理的整个范围内的护理和治疗方法。我们提出两个新的具体目标： 1.预测儿科创新诊断技术的最佳位置和价值 艾滋病毒，包括婴儿艾滋病毒诊断的护理点检测。 2.评估实施新的抗逆转录病毒药物指南的最有效和最具成本效益的方法， 为儿童引进新的抗逆转录病毒制剂，包括计划推出的度鲁特韦。 该提案的目标是帮助卫生部、世卫组织和 PEPFAR确定稀缺资源的最佳使用，以改善艾滋病毒感染儿童的长期健康。 继续和扩大对CEPAC-儿科建模计划的支持将使我们能够开发和 传播新的建模方法，并解决关键的，特定于上下文的问题，如何使 为全世界数百万受艾滋病毒影响的儿童提供最佳的创新技术和治疗。