Cardiovascular Disease in South African HIV Patients: Value of Prevention

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 DESCRIPTION (provided by applicant): Cardiovascular disease (CVD), including stroke and myocardial infarction (MI), is an emerging public health concern in South Africa. Because of a rising incidence of CVD risk factors such as hypertension and diabetes, South Africa, and all of sub-Saharan Africa, are likely to experience a dramatic increase in CVD in the coming decades. HIV-infected patients are at a particularly increased risk for stroke and MI, as demonstrated in multiple US and European cohorts, especially in the setting of successful treatment with antiretroviral therapy (ART). When coupled with the already increasing incidence of CVD among the general population in South Africa, HIV- infected patients in South Africa are likely to be at major risk for CVD. Further research is essential to assess the scope of this emerging problem, as well as strategies to reduce associated morbidity and mortality. The NIH Office of AIDS Research for FY 2015, as well as the WHO Priority Agenda for global research priorities in CVD, have called for further investigation of these public health concerns. By using simulation modeling to investigate both CVD and HIV in South Africa, this proposed research will examine the long-term impact of CVD among people living with HIV/AIDS with the following aims: 1) To develop a novel state-transition model of CVD risk and outcomes in South Africa and to project the clinical impact of CVD in the general population. 2) To assess the competing risks of CVD and HIV in South Africa using the novel CVD model with an established HIV simulation model. 3) To compare the clinical impact, costs, and cost-effectiveness of screening, treatment, and integration of care for hypertension in HIV-infected patients. The simulation modeling approach will also assess the potential for public health interventions to improve clinical outcomes and to provide cost-effective strategies to reduce CVD risks. The research proposed in this K01 proposal will build on my previous training in clinical epidemiology and mathematical modeling, with additional focused mentorship by Drs. Kenneth Freedberg and Milton Weinstein, to develop simulation models of CVD risks, outcomes, and interventions that will allow for cost-effectiveness analyses. The proposed training plan and research experience will provide the foundation for a career as an independent investigator focused on the dual epidemic of CVD and HIV in sub-Saharan Africa.