Optimizing HIV Care in Less Developed Countries

优化欠发达国家的艾滋病毒护理

• 批准号: 9750311
• 负责人: Kenneth Alan Freedberg
• 金额: $ 81.66万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-07-01 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9750311
• 关键词: AIDS prevention; AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Address; Affect; Area; Brazil; Budgets; Caring; Cessation of life; Characteristics; Clinical; Clinical Management; Clinical Trials; Collaborations; Comprehensive Health Care; Computers; Continuity of Patient Care; Cost Analysis; Country; Data; Developing Countries; Development; Epidemic; Epidemiology; Face; Funding; Goals; Guidelines; HIV; HIV Infections; HIV therapy; Health; Human immunodeficiency virus test; Incidence; Income; India; Infection; Injectable; International; Intervention; Investments; Ivory Coast; Leadership; Life Expectancy; Link; Methods; Modeling; Monitor; Morbidity - disease rate; NIH Office of AIDS Research; Natural History; Oral; Outcome; Patients; Policies; Population; Prevention; Prevention strategy; Preventive Intervention; Prostitution; Regimen; Research; Research Personnel; Research Priority; Resource Allocation; Resources; South Africa; Structure; Testing; United States; United States National Institutes of Health; Viral; Viral Load result; Vulnerable Populations; antiretroviral therapy; base; clinical implementation; cost effective; cost effectiveness; cost-effectiveness evaluation; effective therapy; evidence base; evidence based guidelines; financial incentive; health disparity; health economics; high risk men; high risk population; improved; improved outcome; innovation; men who have sex with men; models and simulation; mortality; multidisciplinary; next generation; novel; pandemic disease; pre-exposure prophylaxis; prevent; randomized trial; research study; tool; treatment guidelines; treatment response; treatment strategy; young woman

Project Summary/Abstract Despite major advances in treatment and prevention of HIV infection, the HIV/AIDS pandemic continues to cause tremendous morbidity and mortality. Of the 36.7 million people living with HIV worldwide, only 57% are receiving antiretroviral therapy. One million people died from AIDS-related illness in 2016, and nearly two million are newly infected with HIV each year. The HIV burden is highest in parts of the world that face the additional challenge of constrained resources. HIV testing and treatment guidelines have continually evolved, capturing the benefits associated with improved testing, more effective antiretroviral therapy and lab monitoring, and increasingly effective prevention interventions. It is clear that the pandemic could be better controlled using existing tools. What remains unclear, however, is what specific strategies and overall approach would be most effective for specific populations, given the important reality of budget constraints. This competing continuation proposes to expand upon the Cost-Effectiveness of Preventing AIDS Complications International (CEPAC-I) Model, a computer microsimulation of the natural history, clinical management, outcomes, costs, and cost-effectiveness of HIV treatment. It will identify the testing, treatment, and prevention interventions that provide the most value in terms of decreasing HIV incidence and improving life expectancy with HIV. The CEPAC-I team, made up of a collaboration of leading HIV investigators, is based in the United States, with key collaborators in South Africa, Côte d'lvoire, India, and Brazil. This team will address critical questions around the cost-effectiveness of new interventions for HIV in high-risk populations. The results will inform clinicians, policymakers, and people living with HIV in multiple resource-limited settings. In addition, this proposal includes development of innovative modeling optimization methods to identify the combinations of testing, treatment, and prevention strategies that will have the greatest impact on specific populations in different countries. This proposal has two specific aims: Specific Aim 1: To expand the CEPAC-I microsimulation to address clinical policy questions, focused on key populations, using data from recent clinical trials and implementation research studies. Specific Aim 2: To develop a novel optimization model to determine the combination of HIV care interventions that maximizes survival, or minimizes HIV incidence, in countries with different epidemic characteristics and different resource constraints. In close alignment with the 2018 research priorities of the NIH Office of AIDS Research, the goals of this proposal include reducing the incidence of HIV, investigating next-generation therapies, identifying optimal prevention and treatment responses, and reducing health disparities by improving outcomes in key populations.

项目总结/摘要 尽管在治疗和预防艾滋病毒感染方面取得了重大进展，但艾滋病毒/艾滋病的流行仍在继续， 导致巨大的发病率和死亡率。在全球3670万艾滋病毒感染者中， 正在接受抗逆转录病毒治疗2016年有100万人死于艾滋病相关疾病， 每年有200万新感染艾滋病毒。艾滋病毒负担在世界上面临艾滋病威胁的地区最高， 资源有限的额外挑战。艾滋病毒检测和治疗指南不断 发展，捕捉与改进的测试，更有效的抗逆转录病毒治疗， 实验室监测和越来越有效的预防干预措施。很明显，这种流行病可能是 更好地利用现有的工具。然而，目前尚不清楚的是， 考虑到预算限制的重要现实，这种方法对特定人群最为有效。 这一相互竞争的延续建议扩大预防艾滋病的成本效益 并发症国际（CEPAC-I）模型，自然史的计算机微观模拟，临床 艾滋病毒治疗的管理、结果、成本和成本效益。它将识别测试， 在降低艾滋病毒发病率方面提供最大价值的治疗和预防干预措施 以及提高艾滋病患者的预期寿命。CEPAC-I团队由艾滋病毒领域的主要合作伙伴 调查人员，总部设在美国，与南非，科特迪瓦，印度和 巴西该小组将解决艾滋病毒新干预措施的成本效益方面的关键问题， 高危人群。研究结果将为临床医生、政策制定者和艾滋病毒感染者提供多方面的信息。 资源有限的环境。此外，该提案还包括开发创新模型， 优化方法，以确定测试，治疗和预防策略的组合， 对不同国家的特定人群影响最大。 这项建议有两个具体目标： 具体目标1：扩展CEPAC-I微观模拟，以解决临床政策问题，重点是 使用最近的临床试验和实施研究的数据。 具体目标2：开发一种新的优化模型，以确定艾滋病毒护理的组合 在流行情况不同的国家采取干预措施，最大限度地提高生存率或最大限度地减少艾滋病毒发病率 特点和不同的资源限制。 与NIH艾滋病研究办公室2018年的研究重点密切一致， 建议包括降低艾滋病毒的发病率，研究下一代疗法，确定最佳的治疗方案， 预防和治疗对策，并通过改善关键领域的成果 人口。