Improving allocation of limited HIV prevention and treatment resources in Zambia

 描述(申请人提供)：克里斯汀·沃尔博士在完成生物医学工程学士学位以及流行病学硕士、博士和博士后研究后，在流行病学方法、数学建模和评估干预措施的有效性的研究方面拥有强大的、专注于定量的基础。沃尔博士目前是埃默里大学的研究助理教授，也是多笔赠款的联合调查员，在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。她也是美国艾滋病毒感染不和谐夫妇暴露前预防可接受性形成评估的首席调查员，以及资助实施将患者记录与赞比亚艾滋病毒预防和治疗服务联系起来的技术的首席调查员。这份K01申请概述了一项为期四年的培训和研究计划，旨在系统地扩展WALL博士的培训和研究背景，以制定一项独特的、独立资助的研究议程，重点是艾滋病毒干预资源的分配。培训计划：沃尔博士建议在以下方面获得能力：1)使用传染病模型进行资源分配，2)建立资源分配优化方案，3)理解卫生政策和实践中的资源分配决策。这些领域的能力将通过教学和多学科指导来实现，这些教授包括：Phaedra Corso博士，NIH资助的研究员和佐治亚大学基金会人类健康教授，在卫生经济评估和将研究结果转化为卫生政策方面有数十年的经验；Ron Brookmeyer博士，NIH资助的研究员和加州大学洛杉矶分校的生物静力学教授，在艾滋病毒流行建模和统计学方面有丰富经验；David HoltGrave博士，NIH资助的教授，约翰斯·霍普金斯大学的教授，世界著名的艾滋病毒预防项目成本效益研究、资源分配和卫生政策专家；亚特兰大疾控中心高级卫生经济学家Arielle Lasry博士的研究重点是艾滋病毒流行建模和美国和非洲艾滋病毒预防和治疗资源分配的优化规划；埃默里经济学院教授和前美国驻赞比亚大使Gordon Streeb博士的工作侧重于非洲卫生经济、政策和发展问题；以及Susan Allen博士，总部设在埃默里的卢旺达赞比亚艾滋病毒研究小组的教授和创始人，他在撒哈拉以南非洲的艾滋病毒预防和治疗工作中拥有超过25年的经验，并有将研究成果转化为赞比亚和赞比亚国家政策的成功历史。 卢旺达。沃尔博士将在埃默里内外寻求指导，她已经在埃默里建立了强大的研究合作者网络。由于埃默里目前没有专注于艾滋病毒项目资源分配优化的教员，她独特的研究议程将与埃默里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、高影响的研究问题：赞比亚艾滋病毒预防和治疗资源的最佳和现实分配是什么，以最大限度地减少特定时间段内的新感染人数？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影响，以及实际的促进者和作出供资决定的障碍。虽然这两个考虑因素很重要，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、协同效应和资源分配决策者面临的现实障碍在内的方法。将建立赞比亚艾滋病毒流行的模型，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。这一模型将被嵌入优化算法，以最大限度地减少赞比亚当前预算中新感染艾滋病毒的人数。之后，WALL博士将对赞比亚卫生部成员和其他关键利益攸关方进行半结构化访谈，以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)优化模型将对干预成本-效果比的假设敏感；2)实际分配方案下避免的艾滋病毒感染数量将显著低于最佳方案；3)影响利益相关者决策的因素将包括国际指导方针、历史分配以及对个别干预措施的社会文化态度。这项拟议的研究与NIH艾滋病研究办公室、NIMH战略研究优先事项和NIMH DAR优先领域保持一致。该项目将是第一个纳入干预协同措施的项目，并研究理性和现实的 在赞比亚分配艾滋病毒项目资源。结果将被用作NIH NIMH R01(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基于证据的资源分配方法产生重要影响。

 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.