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: 8697008
• 负责人: Yu-Hsiang Hsieh
• 金额: $ 13.22万
• 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/8697008
• 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; 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; 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; 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; injection drug use; inner city; innovation; insight; mathematical model; methicillin resistant Staphylococcus aureus; novel strategies; outreach; professor; programs; prospective; response; responsible research conduct; routine practice; screening; 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(申请人提供)：这份为期四年的K01奖项申请是为了为约翰霍普金斯大学急诊医学助理教授谢玉祥博士提供跨学科的强化培训和职业发展指导，使他成为一名独立的研究人员。在美国国立卫生研究院资助、经验丰富的全球知名导师Richard Rothman博士、Joshua Epstein博士和David HoltGrave博士的指导下，谢博士将获得一套互补的跨学科技能，使他能够从事专注于设计和评估急性护理环境中传染病的公共卫生干预措施的研究。申请者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；以及成本效益分析。这项工作的基本原理是评估艾滋病毒筛查策略，因为在过去的十年里，美国的艾滋病毒发病率保持不变，五分之一的感染者仍然不知道自己的血清状态。疾控中心最近提出的控制疫情的基石之一是在急诊科(ED)环境中进行广泛筛查。虽然美国各地越来越多的急诊室制定了将艾滋病毒检测纳入日常实践的战略，但还没有努力系统性地 解决基于ED的艾滋病毒检测的效果如何(相对于没有基于ED的检测)，或者，在识别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。一种相对较新和创新的计算建模方法-基于代理的建模(ABM)，提供了一种潜在的方法来处理与基于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力学的复杂性，并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。本研究项目的目标是：1)使用ABM方法推导出一个计算模型，用于测量ED HIV检测计划对马里兰州巴尔的摩市HIV流行的影响；2)验证推导出的ABM模型；3)基于验证后的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的艾滋病毒检测计划的方法提供新的见解，并提供重要的成本效益数据，为地方和国家的艾滋病毒检测战略提供参考。K01奖将为谢博士提供两个新学科的密集和有指导的研究经验-传染病计算数学模型，特别是ABM，以及成本效益分析。他还将接受负责任地进行研究方面的必要培训，以及来自经验团队的纵向职业指导。这些经验将使他具备必要的基本培训和指导，以成为一名杰出的跨学科独立公共卫生调查员，他将建立一个专注于紧急和急性护理场所传染病研究的研究计划。 项目简介：自2006年以来，美国以急诊科为基础的艾滋病毒检测项目已经确认了数千名以前未被诊断出的艾滋病毒感染者，当时美国疾病控制和预防中心开始积极推动在这个非传统的医疗保健场所进行检测。申请者将在传染病数学建模方面进行一段时间的多学科强化培训，特别是基于代理人的建模和成本效益分析，将这些方法应用于研究急性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，加上国家认可的专家导师团队，将使其成为独立的调查员，并致力于公共卫生干预战略的开发和评估研究，以应对在紧急情况和其他急性事件护理环境中看到的各种传染病威胁。