Cardiovascular Disease in South African HIV Patients: Value of Prevention

南非艾滋病毒患者的心血管疾病：预防的价值

• 批准号: 9205462
• 负责人: Emily Parker Hyle
• 金额: $ 17.93万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-01-15 至 2020-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9205462
• 关键词: AIDS prevention; AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Address; Adherence; Africa South of the Sahara; African; Aging-Related Process; Algorithms; Cardiovascular Diseases; Cardiovascular Models; Caring; Clinical; Clinical Trials; Collaborations; Comorbidity; Cost Effectiveness Analysis; Coupled; Data; Decision Making; Development; Diabetes Mellitus; Diagnosis; Disease; Disease Management; Disease model; Epidemic; Epidemiology; Europe; European; Event; Foundations; Funding; General Population; HIV; HIV risk; Healthcare; Hypertension; Incidence; Individual; International; Intervention; Investigation; Longevity; Mentors; Mentorship; Metabolic; Methodology; Methods; Modeling; Modification; Morbidity - disease rate; Myocardial Infarction; Outcome; Patients; Policies; Population; Prevention; Public Health; Research; Research Personnel; Research Priority; Risk; Risk Factors; Risk Reduction; Scientist; Source; South Africa; South African; Stroke; Time; Training; Uncertainty; United States National Institutes of Health; World Health Organization; antiretroviral therapy; cardiovascular disorder risk; career; clinical care; clinical epidemiology; cohort; combat; cost; cost effective; cost effectiveness; disorder risk; experience; improved; low and middle-income countries; mathematical model; models and simulation; mortality; multidisciplinary; novel; prevent; programs; public health intervention; public health relevance; screening; skills; treatment effect

 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.

 描述(申请人提供)：心血管疾病(CVD)，包括中风和心肌梗死(MI)，在南非是一个新的公共卫生问题。由于高血压和糖尿病等心血管疾病危险因素的发病率不断上升，南非和所有撒哈拉以南非洲地区在未来几十年可能会经历心血管疾病的急剧增加。正如美国和欧洲的多个队列所证明的那样，艾滋病毒感染患者中风和心肌梗塞的风险特别高，特别是在抗逆转录病毒疗法(ART)成功治疗的背景下。再加上南非普通人群的心血管疾病发病率已经在增加，南非的艾滋病毒感染患者很可能面临患心血管疾病的主要风险。进一步的研究对于评估这一新出现的问题的范围以及减少相关发病率和死亡率的战略至关重要。NIH 2015财年艾滋病研究办公室以及世卫组织关于心血管疾病全球研究优先事项的优先议程呼吁对这些公共卫生问题进行进一步调查。通过使用模拟模型来研究南非的心血管疾病和艾滋病毒，这项拟议的研究将检验心血管疾病对艾滋病毒/艾滋病患者的长期影响，目的如下：1)建立南非心血管疾病风险和结果的新的状态转换模型，并预测心血管疾病在普通人群中的临床影响。2)使用新的心血管疾病模型和已建立的艾滋病毒模拟模型来评估南非心血管疾病和艾滋病毒的竞争风险。3)比较HIV感染患者高血压筛查、治疗和综合护理的临床影响、成本和成本效益。模拟建模方法还将评估公共卫生干预改善临床结果的潜力，并提供降低心血管疾病风险的具有成本效益的战略。这项K01提案中提议的研究将建立在我之前的临床流行病学和数学建模培训的基础上，并由Kenneth Freedberg博士和Milton Weinstein博士提供额外的重点指导，以开发允许进行成本效益分析的心血管疾病风险、结果和干预的模拟模型。拟议的培训计划和研究经验将为以撒哈拉以南非洲心血管疾病和艾滋病毒双重流行为重点的独立调查员的职业生涯奠定基础。