Optimal Medication Dispensing for People Living with HIV with and without Other Chronic Diseases in Zambia: A Mathematical Model

项目总结 在当前的普遍抗逆转录病毒治疗(ART)时代，卫生系统面临着优化 照顾越来越多的艾滋病毒携带者和接受抗逆转录病毒治疗的不同群体，这些人也是慢性的， 终身治疗非传染性疾病(NCDs)。差异化服务交付(DSD)是 作为一种手段来对抗抗逆转录病毒药物的次优长期保留，并提高 通过简化和调整级联过程中的护理来利用资源，并由患者偏好和 需求，同时减轻个人和卫生系统不必要的负担。还有很多事情要做 但是，我了解DSD模式是否适用于多个 以及如何为特定人群和卫生系统找到最优的DSD模式。使用大型的 对于赞比亚常规收集的病历患者数据集，我建议创建一个动态微观模拟 疾病和服务提供模式--侧重于有或没有其他慢性病的艾滋病毒，如 糖尿病-确定最优药物分配策略的潜在好处和成本。我希望 替代药物调配策略的成本效益将取决于服务量，患者 结果、单位成本和诊所内拥堵的概率。这项研究将直接为政策提供信息 关于应如何实施可持续发展模式以改善人口健康结果和 计划的成本效益。目标1和目标2将构建艾滋病毒服务提供强度、能力、 密度和频率，按患者/设施组评估分布，并评估药物的规模经济 针对患有和不患有糖尿病等其他慢性疾病的艾滋病毒的分发策略。我将建立一个模型来 使用集成的多个月药物量化服务能力和利用率增加的程度 艾滋病毒和糖尿病的分配战略，基于稳定/并存患者的比例、单位时间/成本 每项服务，以及诊所容量。目标3将预测一体化的长期影响和成本效益 有其他慢性病和无其他慢性病的艾滋病毒药物分配战略。我的模型将估计是否和 服务整合和数月配药能在多大程度上改变总体治疗启动和 以及如何反过来改变诊所拥堵的概率、单位成本、治疗 保留/服务质量和成本效益。波士顿大学医学院的主要研究环境 校园，将有助于拟议项目的成功，因为它提供了丰富的多学科机构 资源，包括对研究和培训的坚定承诺以及充足的部门设施和 资源。我可以获得必要的资源和数据来完成拟议的研究。穿过 这个导师研究培训奖，我将获得传染病传播建模和专业知识 成本效益，以及成功编写赠款的经验。

PROJECT SUMMARY In the current era of universal antiretroviral treatment (ART), health systems have the challenge of optimizing care for a growing number of diverse groups of people living with HIV and on ART who are also on chronic, life-long treatment for non-communicable diseases (NCDs). Differentiated service delivery (DSD) was developed as a means to combat suboptimal long-term retention on ART and increase the efficiency of resource utilization by simplifying and adapting care along the cascade, guided by patient preferences and needs, while reducing unnecessary burdens on individuals and the health system. Much remains to be understood, however, about whether DSD models will work for integrated service delivery for multiple conditions and how to find the optimal DSD model for specific populations and health systems. Using a large patient dataset of routinely collected medical records in Zambia, I propose to create a dynamic microsimulation model of disease and service delivery – focusing on HIV with and without other chronic diseases such as diabetes – to identify the potential benefits and costs of an optimal medication dispensing strategy. I expect that the cost-effectiveness of alternative drug dispensing strategies will be a function of service volume, patient outcomes, unit costs, and probability of congestion within clinics. This research will directly inform policy questions relating to how DSD models should be implemented to improve population health outcomes and program cost-effectiveness. Aims 1 and 2 will construct HIV service delivery indices of intensity, capacity, density, and frequency, assess distributions by patient/facility groups, and evaluate economies of scale of drug dispensing strategies for HIV with and without other chronic diseases such as diabetes. I will build a model to quantify the extent of service capacity and utilization increase using an integrated and multi-month drug dispensing strategy for HIV and diabetes, based on the proportion of stable/comorbid patients, unit time/cost per service, and clinic capacity. Aim 3 will project the long-term impact and cost-effectiveness of an integrated drug dispensing strategy for HIV with and without other chronic diseases. My model will estimate whether and to what extent service integration and multi-month drug dispensing can change total treatment initiation and retention in a clinic and how that may in turn change the probability of clinic congestion, unit costs, treatment retention/service quality, and cost effectiveness. The primary research environment, Boston University Medical Campus, will contribute to the success of the proposed project, as it provides rich, multidisciplinary institutional resources, including a strong commitment to research and training and ample departmental facilities and resources. I have access to the necessary resources and data to complete the proposed research. Through this mentored research training award, I will gain expertise in infectious diseases transmission modeling and cost-effectiveness, and experience of successful grant writing.