Cost-Effectiveness of ED HIV Testing Program Agent-Based Modeling Approach

ED HIV 检测计划基于代理的建模方法的成本效益

• 批准号: 8467090
• 负责人: Yu-Hsiang Hsieh
• 金额: $ 13.63万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-08-15 至 2016-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8467090
• 关键词: AIDS prevention; AIDS/HIV problem; Accident and Emergency department; Acute; Address; Affect; Area; Baltimore; Behavior; Caring; Centers for Disease Control and Prevention (U.S.); Characteristics; Cities; Clinic; Clinical Trials; Communicable Diseases; Communities; Complex; Computer Simulation; Computer software; Computing Methodologies; Cost Effectiveness Analysis; Coupled; Data; Development; Diagnostic tests; Discipline; Doctor of Philosophy; Drug usage; Ear; Effectiveness; Emergency Medicine; Emergency Situation; Environment; Epidemic; Epidemiologic Studies; Epidemiology; Evaluation; Exposure to; Funding; Goals; HIV; Health Care Seeking Behavior; Healthcare; Heterogeneity; High Prevalence; Human; Human immunodeficiency virus test; Incidence; Individual; Infection; Infection Control; Influenza A Virus, H1N1 Subtype; Injection of therapeutic agent; Intervention; Lead; Maryland; Measures; Medical; Mentored Research Scientist Development Award; Mentors; Mentorship; Methods; Mission; Modeling; Movement; Observational Study; Outcomes Research; Play; Population; Prevention strategy; Public Health; Recording of previous events; Relative (related person); Research; Research Design; Research Personnel; Research Project Grants; Research Scientist Award; Screening procedure; Seroepidemiologic Studies; Services; Sex Behavior; Simulate; Smallpox; Societies; Structure; Techniques; Testing; Time; Training; United States; United States National Institutes of Health; Universities; Validation; Work; base; care seeking; career; career development; cost; cost effective; cost effectiveness; demographics; design; disorder prevention; experience; high risk behavior; inner city; innovation; insight; mathematical model; methicillin resistant Staphylococcus aureus; novel strategies; outreach; professor; programs; prospective; response; responsible research conduct; routine practice; skills; social; transmission process

DESCRIPTION (provided by applicant): This four-year K01 award application is to provide intensive multi-disciplinary training and career development guidance for Dr. Yu-Hsiang Hsieh, PhD, an Assistant Professor in Emergency Medicine at the Johns Hopkins University, leading to his becoming an independent investigator. Under the guidance of world renowned, NIH-funded, experienced mentors, Drs. Richard Rothman, Joshua Epstein, and David Holtgrave, Dr. Hsieh will gain a set of complementary inter-disciplinary skills which will allow him to pursue research with a focus on devising and evaluating public health interventions for infectious diseases seen in acute care settings. The applicant will receive mentoring in: public health aspects of emergency medicine; infectious disease computational mathematical modeling; and cost-effectiveness analysis. The rationale for the work, evaluation of HIV screening strategies, comes from the fact that HIV incidence has remained unchanged in the U.S. over the past decade, with one in five infected remaining unaware of their serostatus. One of the cornerstones recently advanced by the CDC for controlling the epidemic is widespread screening in emergency department (ED) settings. While, increasing numbers of EDs across the U.S. have developed strategies to adapt HIV testing into routine practice, there have been no efforts to systematically address how effective ED-based HIV testing has been (relative to no ED-based testing), or, which of several testing strategies is optimal with regard to identifying the largest number of unrecognized cases, and decreasing community HIV transmission. A relatively new and innovative method of computational modeling, agent-based modeling (ABM), offers a potential means for handling the complexity of temporal dynamics of HIV epidemiology and human behaviors associated with availability of ED-based HIV testing services, and represents a promising approach for overcoming many of the shortcoming of conventional study designs. The goal of this research project is to: 1) derive a computational model for measuring the impact of ED HIV testing programs on the HIV epidemic in Baltimore, Maryland, using ABM methods; 2) validate the derived ABM model; and 3) assess relative cost- effectiveness of ED HIV testing programs based on findings from the validated ABM model. The results of this study will provide new insights regarding current approaches to ED-based HIV testing programs and provide important cost-effectiveness data to inform local and national HIV testing strategies. The K01 award will provide Dr. Hsieh an intensive and directed mentored research experience in two new disciplines for him - infectious disease computational mathematical modeling, particularly ABM, and cost-effectiveness analysis. He will also receive needed training in the responsible conduct of research as well as longitudinal career guidance from an experience team. Together these experiences will equip him with the essential training and mentorship necessary to become an outstanding interdisciplinary independent public health investigator, who will build a research program focused on the study of infectious diseases in emergent, and acute care venues. PROJECT NARRATIVE: Emergency department-based HIV testing programs in the United States have identified thousands of previously undiagnosed HIV-infected individuals since 2006, when the Centers of Disease Control and Prevention began to aggressively promote testing in this non-traditional health care venue. The applicant will pursue a period of intensive multi-disciplinary training in infectious disease mathematical modeling - particularly agent based modeling, and cost-effectiveness analysis, applying these methods to study public health screening in acute care settings. The rich research environment of Johns Hopkins University coupled with the nationally recognized team of expert mentors will lead to independent investigator status, and a career dedicated to research in the development and evaluation of public health intervention strategies which address a wide array of infectious diseases' threats seen in emergency and other acute episodic care settings.

描述（由申请人提供）：本次为期四年的K01奖申请旨在为约翰·霍普金斯大学急诊医学助理教授谢宇翔博士提供密集的多学科培训和职业发展指导，使他成为一名独立研究者。在世界著名的、由 NIH 资助、经验丰富的导师的指导下，博士。谢博士将由理查德·罗斯曼 (Richard Rothman)、约书亚·爱泼斯坦 (Joshua Epstein) 和大卫·霍尔特格雷夫 (David Holtgrave) 获得一系列互补的跨学科技能，这将使他能够开展研究，重点是设计和评估针对急症护理环境中出现的传染病的公共卫生干预措施。申请人将接受以下方面的指导： 急诊医学的公共卫生方面；传染病计算数学模型；和成本效益分析。这项工作的基本原理是对艾滋病毒筛查策略进行评估，其理由是美国的艾滋病毒发病率在过去十年中保持不变，五分之一的感染者仍然不知道自己的血清状况。疾病预防控制中心最近为控制流行病而提出的基石之一是在急诊室（ED）环境中进行广泛的筛查。虽然美国各地越来越多的急诊室已经制定了策略，将艾滋病毒检测纳入常规实践，但还没有做出系统性的努力 说明基于急诊科的艾滋病毒检测的有效性如何（相对于不基于急诊科的检测），或者在确定最大数量的未识别病例和减少社区艾滋病毒传播方面，几种检测策略中哪一种是最佳的。基于主体的建模 (ABM) 是一种相对较新且创新的计算建模方法，为处理与基于 ED 的 HIV 检测服务的可用性相关的 HIV 流行病学和人类行为的时间动态复杂性提供了一种潜在的方法，并且代表了一种克服传统研究设计的许多缺点的有前途的方法。该研究项目的目标是： 1) 使用 ABM 方法推导出计算模型，用于衡量 ED HIV 检测项目对马里兰州巴尔的摩市 HIV 流行的影响； 2）验证导出的ABM模型； 3) 根据经过验证的 ABM 模型的结果评估 ED HIV 检测计划的相对成本效益。这项研究的结果将为当前基于 ED 的 HIV 检测项目的方法提供新的见解，并提供重要的成本效益数据，为当地和国家的 HIV 检测策略提供信息。 K01 奖将为谢博士提供两个新学科的密集和定向指导研究经验：传染病计算数学模型，特别是 ABM 和成本效益分析。他还将接受负责任的研究行为所需的培训以及经验团队的纵向职业指导。这些经验将为他提供必要的培训和指导，成为一名杰出的跨学科独立公共卫生调查员，他将建立一个研究项目，重点研究急诊和急症护理场所的传染病。 项目叙述：自 2006 年疾病控制与预防中心开始在这一非传统医疗保健场所积极推广检测以来，美国基于急诊科的 HIV 检测项目已识别出数千名先前未确诊的 HIV 感染者。申请人将在传染病数学建模方面进行一段时间的强化多学科培训，特别是基于代理的建模和成本效益分析，应用这些方法来研究急症护理环境中的公共卫生筛查。约翰·霍普金斯大学丰富的研究环境加上全国公认的专家导师团队将带来独立研究者地位，以及致力于研究制定和评估公共卫生干预策略的职业生涯，这些策略可解决紧急情况和其他急性突发护理环境中出现的各种传染病威胁。