Improving allocation of limited HIV prevention and treatment resources in Zambia

改善赞比亚有限的艾滋病毒预防和治疗资源的分配

• 批准号: 9230869
• 负责人: Kristin Marie Wall
• 金额: $ 12.81万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-02-23 至 2020-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9230869
• 关键词: AIDS prevention; AIDS/HIV problem; Advocacy; Africa; Africa South of the Sahara; Algorithms; Anti-Retroviral Agents; Area; Attitude; Biomedical Engineering; Budgets; Centers for Disease Control and Prevention (U.S.); Communities; Competence; Cost effectiveness research; Counseling; Country; Couples; Data; Decision Making; Development; Disease model; Doctor of Philosophy; Drops; Economics; Effectiveness of Interventions; Epidemic; Epidemiologic Methods; Epidemiology; Ethics; Evidence based intervention; Faculty; Family Planning; Fellowship; Foundations; Funding; Government; Grant; Guidelines; HIV; HIV Infections; Health; Health Benefit; Health Personnel; Health Policy; Human; Human immunodeficiency virus test; Incidence; Individual; Infection; Instruction; International; Intervention; Interview; Investigation; Light; Link; Male Circumcision; Mathematics; Measures; Mentored Research Scientist Development Award; Mentors; Mentorship; Methodology; Methods; Modeling; NIH Office of AIDS Research; National Institute of Mental Health; Outcome; Output; Patients; Policies; Policy Developments; Politics; Population Intervention; Population Programs; Postdoctoral Fellow; Prevention; Prevention program; Preventive Intervention; Principal Investigator; Production; Recording of previous events; Records; Research; Research Assistant; Research Personnel; Research Priority; Resource Allocation; Resources; Risk; Rwanda; Self-Direction; Services; Strategic Planning; Structure; Technology; Testing; Therapeutic; Time; Training; Translating; Translations; Treatment outcome; United States; United States National Institutes of Health; Universities; Vertical Disease Transmission; Work; Zambia; base; cost; cost effectiveness; cost-effectiveness ratio; economic evaluation; evidence base; experience; fighting; formative assessment; health economics; health practice; improved; infectious disease model; innovation; intervention effect; mathematical model; member; multidisciplinary; pre-exposure prophylaxis; prevent; professor; programs; public health relevance; social; standard of care; statistics; synergism; trend

 DESCRIPTION (provided by applicant): Having completed a BS in Biomedical Engineering and a MS, PhD, and post-doctoral fellowship in Epidemiology, Dr. Kristin Wall possesses a strong, quantitatively focused foundation in epidemiological methods, mathematical modeling, and research evaluating the effectiveness of interventions to treat and prevent HIV. Dr. Wall is currently a Research Assistant Professor at Emory University and co-Investigator on multiple grants to implement and evaluate couples-focused HIV testing and family planning interventions in Zambia and Rwanda. She is also Principal Investigator on a formative evaluation of pre-exposure prophylaxis acceptability among HIV discordant couples in the United States and the Principal Investigator on a grant to implement technologies that link patient records across HIV prevention and treatment services in Zambia. This K01 application outlines a four-year training and research plan structured to systematically expand upon Dr. Wall's training and research background to develop a unique, independently funded research agenda focused on HIV intervention resource allocation. Training plan: Dr. Wall proposes to gain competency in: 1) using infectious disease models for resource allocation, 2) building resource allocation optimization programs, and 3) understanding resource allocation decisions in health policy and practice. Competency in these areas will be achieved through didactic instruction and multidisciplinary mentorship from Dr. Phaedra Corso, an NIH-funded researcher and University of Georgia Foundation Professor of Human Health with decades of experience in health economic evaluation and translation of findings into health policy; Dr. Ron Brookmeyer, an NIH-funded researcher and UCLA Professor of Biostatics with extensive experience in HIV epidemic modeling and statistics; Dr. David Holtgrave, an NIH-funded Professor at Johns Hopkins and world-renowned expert in cost-effectiveness research, resource allocation, and health policy for HIV prevention programs; Dr. Arielle Lasry, Senior Health Economist at CDC Atlanta whose research focuses on HIV epidemic modeling and optimization programming for HIV prevention and treatment resource allocation in the United States and Africa; Dr. Gordon Streeb, Professor in the Emory Department of Economics and former United States Ambassador to Zambia whose work focuses on health economics, policy, development issues in Africa; and Dr. Susan Allen, Professor and founder of the Emory-based Rwanda Zambia HIV Research Group with more than 25 years of experience working in HIV prevention and treatment in sub-Saharan Africa and a successful history of translating research findings into national policy in Zambia and Rwanda. Dr. Wall will seek mentorship within and outside of Emory, where she has already built a strong network of research collaborators. As Emory does not currently house faculty focused on resource allocation optimization for HIV programs, her unique research agenda will be highly complementary to the existing HIV-related research portfolio at Emory. Research plan: Dr. Wall proposes to develop methods to optimize the allocation of limited HIV prevention and treatment resources to improve a defined health outcome. She will apply these methods to answer a relevant, timely, high-impact research question: what is an optimal and realistic allocation of combination HIV prevention and treatment resources in Zambia to minimize the number of new infections over a given time period? Two important resource allocation considerations are the leveraged costs and effects of interventions in combination and the realistic facilitators and barriers to making funding decisions. Though important, these two considerations are rarely systematically incorporated into resource allocation analyses. Dr. Wall proposes to advance methods that are inclusive of intervention synergy and real-world barriers facing resource allocation decision-makers. Models of the Zambian HIV epidemic that output the number of new HIV infections over time given a specific resource allocation scenario will be constructed. This model will be embedded in an optimization algorithm to minimize the number of new HIV infections for the current Zambian budget. Dr. Wall will then conduct formative qualitative work to determine the political, social, cultural, and ethical factors that influence HIV program resource allocation decision-making in Zambia by conducting semi-structured interviews with Ministry of Health members and other key stakeholders. Dr. Wall hypothesizes that: 1) the optimization model will be sensitive to assumptions of intervention cost-effectiveness ratios; 2) the number of HIV infections averted under the actual allocation scenario will be significantly lower than that for the optimal scenario; and 3) factors influencing stakeholder decision-making will include international guidelines, historical allocations, and sociocultural attitudes toward individual interventions. The proposed research aligns with the NIH Office of AIDS Research, NIMH Strategic Research Priorities, and NIMH DAR areas of high priority. The project will be the first to incorporate measures of intervention synergy and study both the rational and realistic allocation of HIV program resources in Zambia. Results will be used as preliminary data for an NIH NIMH R01 (highly responsive to PA-14-131) to develop the allocation model in light of changing guidelines and formative results. These investigations could inform decision-making in Zambia that improves HIV prevention and treatment outcomes. More broadly, the results of this work will have important implications for developing evidence-based resource allocation methodologies.

 描述（由申请人提供）：完成了生物医学工程学士学位和流行病学硕士，博士和博士后奖学金，Kristin Wall博士在流行病学方法，数学建模和研究评估干预措施的有效性方面拥有强大的，定量的基础，以治疗和预防艾滋病毒。沃尔博士目前是埃默里大学的研究助理教授，也是赞比亚和卢旺达实施和评估以夫妇为重点的艾滋病毒检测和计划生育干预措施的多项赠款的共同研究者。她还是美国艾滋病毒不和谐夫妇中暴露前预防可接受性形成性评估的主要研究员，以及赞比亚艾滋病毒预防和治疗服务中实施患者记录链接技术的主要研究员。K 01申请概述了一个为期四年的培训和研究计划，旨在系统地扩展沃尔博士的培训和研究背景，以制定一个独特的、独立资助的研究议程，重点是艾滋病毒干预资源分配。 培训计划：沃尔博士建议获得以下能力：1）使用传染病模型进行资源分配，2）建立资源分配优化计划，3）了解卫生政策和实践中的资源分配决策。Phaedra Corso博士是美国国立卫生研究院资助的研究员，也是格鲁吉亚大学人类健康基金会教授，在卫生经济评估和将研究结果转化为卫生政策方面拥有数十年的经验;罗恩布鲁克迈耶博士是美国国立卫生研究院资助的研究员，也是加州大学洛杉矶分校生物统计学教授，在艾滋病毒流行建模和统计方面拥有丰富的经验;大卫Holtgrave博士，美国国立卫生研究院资助的教授在约翰霍普金斯和世界著名的专家在成本效益研究，资源分配，和卫生政策的艾滋病毒预防计划; Arielle Lasry博士，高级卫生经济学家在疾病预防控制中心亚特兰大其研究重点是艾滋病毒流行建模和优化规划艾滋病毒预防和治疗资源分配在美国和非洲; Gordon Streeb博士，埃默里经济系教授，前美国驻赞比亚大使，其工作重点是非洲的卫生经济学、政策和发展问题;和苏珊·艾伦博士，埃默里大学的教授和创始人-总部设在卢旺达赞比亚艾滋病毒研究小组，在艾滋病毒预防和治疗方面有25年以上的工作经验，撒哈拉非洲和赞比亚将研究成果转化为国家政策的成功历史， 卢旺达.沃尔博士将在埃默里大学内外寻求指导，在那里她已经建立了一个强大的研究合作者网络。由于埃默里大学目前没有专注于艾滋病毒项目资源分配优化的教师，她独特的研究议程将与埃默里大学现有的艾滋病毒相关研究组合形成高度互补。 研究计划：沃尔博士建议制定方法，优化有限的艾滋病毒预防和治疗资源的分配，以改善明确的健康结果。她将应用这些方法来回答一个相关的，及时的，高影响力的研究问题：什么是最佳和现实的分配组合艾滋病毒预防和治疗资源在赞比亚，以尽量减少新感染的数量在一个给定的时间段？两个重要的资源分配考虑因素是综合干预措施的杠杆成本和效果，以及作出供资决定的现实促进因素和障碍。这两项考虑虽然重要，但很少系统地纳入资源分配分析。沃尔博士建议推进包括干预协同作用和资源分配决策者面临的现实障碍的方法。将建立赞比亚艾滋病毒流行病模型，在特定的资源分配情况下，输出一段时间内新感染艾滋病毒的人数。该模型将嵌入优化算法，以最大限度地减少赞比亚当前预算中的新艾滋病毒感染人数。然后，沃尔博士将进行形成性定性工作，通过与卫生部成员和其他关键利益相关者进行半结构化访谈，确定影响赞比亚艾滋病毒项目资源分配决策的政治、社会、文化和伦理因素。沃尔博士假设：1）最优化模型对干预措施的成本-效果比假设敏感; 2）实际分配方案下避免的艾滋病毒感染人数将显著低于最优方案; 3）影响利益相关者决策的因素包括国际指导方针、历史分配以及对个别干预措施的社会文化态度。拟议的研究与NIH艾滋病研究办公室，NIMH战略研究优先事项和NIMH DAR高度优先领域保持一致。该项目将是第一个纳入干预协同措施，并研究合理和现实的 赞比亚艾滋病毒方案资源的分配。结果将用作NIH NIMH R 01（对PA-14-131高度响应）的初步数据，以根据不断变化的指南和形成性结果开发分配模型。这些调查可以为赞比亚改善艾滋病毒预防和治疗结果的决策提供信息。更广泛地说，这项工作的结果将对制定循证资源分配方法产生重要影响。