Estimating the cost-effectiveness of HIV pre-exposure prophylaxis delivery through maternal and child health clinics in Kenya

评估肯尼亚妇幼保健诊所提供艾滋病毒暴露前预防的成本效益

• 批准号: 9926435
• 负责人: David Allen Roberts
• 金额: $ 4.07万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-16 至 2023-09-15
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9926435
• 关键词: AIDS prevention; Adherence; Affect; Africa South of the Sahara; Behavioral; Benchmarking; Breast Feeding; Budgets; Capital; Cessation of life; Characteristics; Clinic; Clinical; Communicable Diseases; Data; Demography; Economic Models; Epidemic; Female; Foundations; HIV; HIV Infections; HIV Seronegativity; HIV risk; Health system; High Risk Woman; Human Resources; Incidence; Individual; Infant; Infection; Intervention; Kenya; Laboratories; Maternal and Child Health; Maternal-Child Health Services; Mentorship; Methods; Modeling; Morbidity - disease rate; National Health Programs; Natural History; Output; Perinatal; Pharmaceutical Preparations; Policies; Population; Postnatal Care; Postpartum Women; Pregnancy; Pregnant Women; Prevention strategy; Preventive Intervention; Provider; Public Health; Publishing; Research Personnel; Resources; Risk; Risk Factors; Screening procedure; Services; Sexually Transmitted Diseases; Solid; Study models; Supervision; Testing; Time; Time and Motion Studies; Training; Uncertainty; Woman; antenatal; antiretroviral therapy; base; career; clinical care; cost; cost effective; cost effectiveness; cost-effectiveness evaluation; cost-effectiveness ratio; design; disability-adjusted life years; female sex worker; health economics; high risk; implementation strategy; incremental cost-effectiveness; mathematical model; medical supply; men who have sex with men; models and simulation; mortality; pre-exposure prophylaxis; prevent; program costs; programs; randomized trial; scale up; sexual relationship; success; targeted delivery; transmission process; trial comparing; uptake; young woman

ABSTRACT HIV disproportionately affects young women, and nearly 200,000 young women in sub-Saharan Africa are infected with HIV each year. Pre-exposure prophylaxis (PrEP) is an effective method for preventing HIV infection and offers promise as a female-controlled intervention. However, effective strategies for efficiently identifying women at high risk of HIV infection and engaging them in PrEP have not been established. Pregnant and postpartum women have elevated risk of HIV infection, and HIV infection acquired during pregnancy can be transmitted to infants perinatally or during breastfeeding. Therefore, integrating PrEP into existing maternal and child health (MCH) clinics could be an efficient strategy for preventing new HIV infections. National health programs operating under limited resources need guidance to determine where to roll out PrEP to maximize impact. The proposed project will use mathematical modeling combined with data from two implementation studies to evaluate the cost-effectiveness of PrEP delivery through MCH clinics in western Kenya. In Aim 1, we will conduct a microcosting study as part of a PrEP demonstration project to estimate the incremental cost of integrating PrEP into routine MCH services. In Aim 2, we will develop an individual-based mathematical model of HIV transmission calibrated to HIV dynamics in western Kenya that simulates HIV natural history, demography, sexual relationship formation, and explicitly models the flow of individuals through HIV and MCH services. Using this model, we will evaluate the population-level impact of PrEP uptake by pregnant and postpartum women attending MCH clinics. Combined with the cost estimates from Aim 1, we will calculate the cost-effectiveness and budget impact of this PrEP delivery strategy compared to standard thresholds and other HIV prevention interventions. A key benchmark of program success is the extent to which PrEP use is prioritized among individuals with high HIV risk. In Aim 3, we will estimate the cost-effectiveness of risk score-guided vs. universal PrEP delivery to pregnant women. This analysis will incorporate results from a randomized trial comparing PrEP uptake, retention, and adherence between the two strategies into the model developed in Aim 2. Together, the results from these Aims will help guide policymakers decide how to most effectively scale up PrEP delivery in sub-Saharan Africa. In addition to these Aims, the proposal describes a rigorous training plan in mathematical modeling, health economics, and clinical care as well as mentorship from leading HIV prevention researchers. Combined, this proposal will provide a solid foundation for a career as an infectious disease clinician and public health researcher contributing to efforts to control the HIV epidemic.

抽象的 艾滋病毒对年轻女性的影响尤为严重，撒哈拉以南非洲地区有近 20 万年轻女性感染艾滋病毒 每年都会感染艾滋病病毒。暴露前预防（PrEP）是预防艾滋病毒感染的有效方法 并有望成为女性控制的干预措施。然而，有效的策略可以有效地识别 尚未确定艾滋病毒感染高危妇女以及让她们参与 PrEP 的情况。怀孕和 产后妇女感染艾滋病毒的风险较高，怀孕期间感染艾滋病毒可 传染给围产期或母乳喂养期间的婴儿。因此，将 PrEP 纳入现有的孕产妇和 儿童健康（MCH）诊所可能是预防新的艾滋病毒感染的有效策略。国民健康 在资源有限的情况下运作的计划需要指导来确定在哪里推出 PrEP 以最大限度地发挥作用 影响。拟议项目将使用数学模型并结合两次实施的数据 评估通过肯尼亚西部妇幼保健诊所提供 PrEP 的成本效益的研究。在目标 1 中，我们 将进行微观成本研究，作为 PrEP 示范项目的一部分，以估算以下项目的增量成本： 将 PrEP 纳入常规 MCH 服务。在目标 2 中，我们将开发一个基于个人的数学模型 根据肯尼亚西部的艾滋病毒动态进行校准，模拟艾滋病毒自然史， 人口统计学、性关系形成，并通过艾滋病毒和妇幼保健明确地模拟个体流动 服务。使用该模型，我们将评估怀孕和怀孕期间 PrEP 摄取对人群水平的影响。 到妇幼保健院就诊的产后妇女。结合目标 1 的成本估算，我们将计算 与标准阈值和其他阈值相比，该 PrEP 实施策略的成本效益和预算影响 艾滋病毒预防干预措施。计划成功的一个关键基准是 PrEP 使用的优先程度 艾滋病毒高危人群。在目标 3 中，我们将评估风险评分引导与非风险评分引导的成本效益。 向孕妇普遍提供 PrEP。该分析将纳入随机试验的结果 将两种策略之间的 PrEP 摄取、保留和依从性与 Aim 开发的模型进行比较 2. 这些目标的结果将帮助指导政策制定者决定如何最有效地扩大规模 撒哈拉以南非洲地区的 PrEP 实施。除了这些目标之外，该提案还描述了严格的培训计划 数学建模、健康经济学和临床护理以及领先的艾滋病毒预防指导 研究人员。总而言之，该提案将为传染病临床医生的职业生涯提供坚实的基础 和公共卫生研究人员为控制艾滋病毒流行做出了贡献。