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

赞比亚患有或不患有其他慢性疾病的艾滋病毒感染者的最佳药物分配：数学模型

• 批准号: 10448273
• 负责人: Youngji Jo
• 金额: $ 7.68万
• 依托单位: BOSTON MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-01 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10448273
• 关键词: AIDS/HIV problem; Address; Age; Award; Behavior; Boston; COVID-19; Caring; Cessation of life; Characteristics; Chronic; Chronic Disease; Clinic; Clinic Visits; Clinical; Congestive; Costs and Benefits; Crowding; Data; Data Analyses; Data Set; Diabetes Mellitus; Disease; Disease model; Environment; Epidemiology; Equilibrium; Event; Failure; Feedback; Frequencies; Genetic; Grant; HIV; Health; Health Status; Health system; Hospitals; Impairment; Individual; Infection; Intervention; Life; Measurable; Measurement; Medical; Medical Records; Mentors; Modeling; Outcome; Patient Care; Patient Preferences; Patient-Centered Care; Patient-Focused Outcomes; Patients; Pattern; Performance; Persons; Pharmaceutical Preparations; Policies; Population; Prevalence; Probability; Research; Research Training; Resource-limited setting; Resources; Service delivery model; Services; System; Testing; Time; Triage; Tuberculosis; Universities; Viral Load result; Visit; Wait Time; Work; Writing; Zambia; adverse outcome; antiretroviral therapy; base; care seeking; combat; comorbidity; cost; cost effectiveness; density; design; disease transmission; experience; follow-up; implementation evaluation; implementation strategy; improved; indexing; mathematical model; multidisciplinary; population health; profiles in patients; program costs; response; service delivery; sex; success

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.

项目总结

项目成果

Model-based cost-effectiveness analysis of oral antivirals against SARS-CoV-2 in Korea.

• DOI: 10.4178/epih.e2022034
• 发表时间: 2022
• 期刊: Epidemiology and health
• 影响因子: 3.8
• 作者: Jo Y;Kim SB;Radnaabaatar M;Huh K;Yoo JH;Peck KR;Park H;Jung J
• 通讯作者: Jung J

Attrition from HIV treatment after enrollment in a differentiated service delivery model: A cohort analysis of routine care in Zambia.

• DOI: 10.1371/journal.pone.0280748
• 发表时间: 2023
• 期刊: PLOS ONE
• 影响因子: 3.7
• 作者: Jo, Youngji;Jamieson, Lise;Phiri, Bevis;Grimsrud, Anna;Mwansa, Muya;Shakwelele, Hilda;Haimbe, Prudence;Mukumbwa-Mwenechanya, Mpande;Mulenga, Priscilla Lumano;Nichols, Brooke E.;Rosen, Sydney
• 通讯作者: Rosen, Sydney

Optimal Social Distancing Policy for COVID-19 Control in Korea: A Model-Based Analysis.

• DOI: 10.3346/jkms.2022.37.e189
• 发表时间: 2022-06-13
• 期刊: JOURNAL OF KOREAN MEDICAL SCIENCE
• 影响因子: 4.5
• 作者: Youngji, Jo;Sourya, Shrestha;Munkhzul, Radnaabaatar;Hojun, Park;Jaehun, Jung
• 通讯作者: Jaehun, Jung