Global Health Comparative Effectiveness: A data synthesis method applied to HIV

说明(由申请者提供)：本提案涉及全球卫生的区域合作框架主题领域。对于艾滋病毒和其他全球重要的健康状况，有数百项研究和数十项审查评估预防和治疗干预措施的效果，数据技术性很强，格式不一致。此外，关于疗效的数据(即，来自临床试验的最佳条件)通常与关于有效性的数据(即，来自真实世界的情况)没有区别。这些限制降低了干预评估研究在制定政策和方案方面的价值。这项研究的目标是开发和实施创新的方法，将现有的艾滋病毒预防和治疗干预措施的健康益处数据转化为全球卫生艾滋病毒政策和方案的准确和透明的经验基础，从而增加实证研究在现实世界实施中的价值和使用。具体目标是：(1)评估艾滋病毒预防和治疗干预措施的有效性和有效性的证据，包括制定描述研究如何反映现实世界实施情况的有效性评分，以及评估干预惠益的大小如何随该评分而变化；(2)通过结合有效性和疾病负担的数据，转化大规模实施的特定干预措施的效果，以估计减少的人口水平的疾病负担；(3)结合有效性、减负和成本，计算干预措施的成本效益；以及，(4)通过网上资源，使决策者和其他技术和非技术最终用户能够方便地获取目标1至3中的调查结果。这项工作的影响可能很大。2015年，艾滋病毒预计将达到每年1.28亿个残疾调整生命年，这是发展中世界最大的负担。因此，我们的合成和分析在编程效率方面的微小收益可能会对健康产生巨大的好处。此外，我们的方法还可以应用于其他全球健康状况。 公共卫生相关性：有数千项研究衡量艾滋病毒预防和治疗干预措施的效果，产生的数据技术性很强，格式不一致，政策制定者通常无法获得。该项目将使用创新和严格的方法，制定关于艾滋病毒干预措施组合的有效性、潜在减少艾滋病毒疾病负担和成本的明确和准确的数据。这项分析将提供有价值的信息和工具，为全球艾滋病毒政策和计划提供信息。

DESCRIPTION (provided by applicant): This proposal addresses the RFA thematic area of global health. For HIV and other globally important health conditions, there are hundreds of studies and dozens of reviews assessing the effects of prevention and treatment interventions, with data that is highly technical and presented in inconsistent formats. In addition, data on efficacy (i.e., from the optimal conditions of clinical trials) is often not distinguished from data on effectiveness (i.e., from real-world circumstances). These limitations reduce the value of intervention assessment studies for the development of policies and programs. The goal of this study is to develop and implement innovative approaches to translate existing data on the health benefits of HIV prevention and treatment interventions into an accurate and transparent empirical basis for global health HIV policies and programs, thus increasing the value and use of empirical studies for real-world implementation. The specific aims are to: (1) assess evidence regarding the efficacy and effectiveness of prevention and treatment interventions for HIV, including the development of an effectiveness score that describes how well studies reflect real-world implementation, and an assessment of how the magnitude of intervention benefit varies with this score; (2) by combining data on effectiveness and disease burden, translate the effect of specified interventions implemented at large scale to estimate reduced population-level disease burden; (3) incorporating effectiveness, burden reduction, and cost, calculate the cost-effectiveness of sets of interventions; and, (4) make findings in Aims 1 to 3 easily accessible to decision-makers and other technical and non-technical end users through a web-based resource. The impact of this work is potentially large. HIV is expected to account for 128 million disability-adjusted life years (DALYs) per year in 2015, the largest burden in the developing world. Thus, small gains in programming efficiency as a result of our syntheses and analyses could have large health benefits. In addition, our methods can be applied to other global health conditions. PUBLIC HEALTH RELEVANCE: There are thousands of studies measuring the effects of HIV prevention and treatment interventions, yielding data that are highly technical, presented in inconsistent formats, and usually inaccessible to policy-makers. This project will use innovative and rigorous methods to develop clear and accurate data on effectiveness, potential reduction in HIV disease burden, and costs for combinations of HIV interventions. The analysis will provide valuable information and tools to inform global HIV policies and programs.