Localized economic modeling to optimize public health strategies for HIV treatment and prevention

本地化经济模型可优化艾滋病毒治疗和预防的公共卫生策略

• 批准号: 9977017
• 负责人: Bohdan Nosyk
• 金额: $ 16万
• 依托单位: SIMON FRASER UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-03-01 至 2021-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9977017
• 关键词: Accounting; Acquired Immunodeficiency Syndrome; Address; Alcohol or Other Drugs use; Annual Reports; Area; Baltimore; Caring; Characteristics; Cities; Consultations; Costs and Benefits; Data; Data Sources; Decision Making; Diagnosis; Disease Surveillance; Drug usage; Economic Models; Effectiveness; Ensure; Epidemic; Epidemiology; Foundations; Frequencies; Funding; Future; Goals; HIV; HIV antiretroviral; HIV risk; Health; Health Benefit; Health Resources; Health Services Accessibility; Healthcare Systems; Human immunodeficiency virus test; Incidence; Individual; Injecting drug user; Injections; International; Intervention; Intervention Studies; Knowledge; Location; Los Angeles; Modeling; Morbidity - disease rate; National Institute of Drug Abuse; Needle-Exchange Programs; New York City; North America; Observational Study; Output; Pattern; Performance; Play; Population; Prevention; Production; Public Health; Publications; Publishing; Reporting; Research; Research Personnel; Resources; Risk; Risk Behaviors; Role; Scientific Advances and Accomplishments; Secure; Services; Site; Specificity; Structure; Substance Use Disorder; Surveys; System; Target Populations; Testing; Time; Translational Research; United States National Institutes of Health; Update; Viral; Work; antiretroviral therapy; burden of illness; cost effective; cost effectiveness; design; effective intervention; experimental study; flexibility; health care delivery; improved; innovation; metropolitan; model development; mortality; national surveillance; novel; opioid agonist therapy; pre-exposure prophylaxis; prevent; programs; public health intervention; response; spatiotemporal; tool; transmission process; trend; uptake; urban setting

SUMMARY Scientific advances in HIV treatment have demonstrated that immediate access to combination antiretroviral therapy (ART) provides both individual and public health benefits. With sufficient uptake of ART, HIV-related morbidity, mortality and transmission can be drastically reduced at the population-level. As a result, the focus of global HIV control strategies have turned towards efforts to ‘seek, test, treat and retain’ people living with HIV (PLHIV) in ART. Emerging research on the cascade of HIV care, a simple metric tracking numbers of individuals infected, diagnosed, on ART and virally suppressed, has made clear that the control of the HIV epidemic hinges on the performance of health care systems in reaching and delivering care to PLHIV. Yet, as a surveillance tool, it provides an incomplete and possibly misleading basis for decisions on how to allocate funding. The US HIV epidemic is a diverse set of microepidemics, dispersed primarily across large urban centers with different underlying epidemiological and structural conditions. These disparate underlying conditions require localized strategies to optimize the HIV care cascade. Changes over time in these microepidemics, as well as in evidence on how to improve HIV testing and care, challenges our ability to make informed and timely decisions that result in the greatest health benefits for the resources invested in treating and preventing HIV. We propose a novel economic modeling framework to revolutionize HIV surveillance. This framework would ensure scarce resources are focused on interventions that can provide the greatest value for money in a given microepidemic. We will build upon a validated economic model to produce rapid, automated evidence synthesis, focusing on minimal data requirements to update the model, and integrate findings from emerging results of public health interventions into real-time disease surveillance systems. Experimental and observational studies of interventions to improve HIV testing and ART engagement have demonstrated their effectiveness in generalized and targeted populations, yet they are vastly underused in practice. Structural interventions for people who inject drugs (PWID), such as needle exchange and opioid agonist therapy (OAT), have proven incredibly valuable in jurisdictions with low barriers to these services, resulting in staggering declines in HIV incidence and disease burden. We hypothesize that a unique mix of these interventions will provide the best value for money in each microepidemic, and that the optimal combinations will change over time according to underlying epidemic trends and the state of scientific advancement in HIV intervention research. We will demonstrate our approach for six distinct urban settings in the US with disparate structural conditions, substance use patterns, and HIV epidemics. This project is an innovative translational research initiative that will enhance surveillance efforts and increase the impact of interventional research in HIV and substance use disorders.

总结 艾滋病毒治疗方面的科学进展表明， 联合抗逆转录病毒疗法（ART）提供了个人和公共卫生福利。与 充分接受抗逆转录病毒疗法，与艾滋病毒有关的发病率、死亡率和传播可大大减少 在人口水平上减少。因此，全球艾滋病毒控制战略的重点已经转向 努力在抗逆转录病毒疗法中“寻找、检测、治疗和留住”艾滋病毒感染者。 关于艾滋病毒护理级联的新研究，一个简单的指标， 感染，诊断，接受抗逆转录病毒治疗和病毒抑制的个体，已经清楚地表明， 艾滋病毒流行的关键取决于卫生保健系统在覆盖和提供服务方面的表现 关注艾滋病病毒。然而，作为一种监督工具，它提供了一个不完整的和可能误导的基础， 决定如何分配资金。 美国的艾滋病毒流行病是一种多样化的微流行病，主要分布在大城市和小城市。 城市中心的潜在流行病学和结构条件不同。这些不同 潜在的条件需要本地化的战略，以优化艾滋病毒护理级联。变动 这些微流行病的时间，以及如何改善艾滋病毒检测和护理的证据， 挑战我们做出明智和及时决策的能力， 艾滋病毒治疗和预防的资源投资的收益。 我们提出了一个新的经济建模框架，以彻底改变艾滋病毒监测。这 框架将确保稀缺的资源集中在能够提供 在特定的微流行病中最有价值。我们将建立在一个有效的经济模式上， 生成快速、自动化的证据合成，专注于最低的数据要求， 更新模型，并将公共卫生干预措施的新结果纳入 实时疾病监测系统。 改进艾滋病毒检测和抗逆转录病毒疗法干预措施的实验性和观察性研究 参与已证明其在一般人群和目标人群中的有效性，但 但在实践中却远远没有得到充分利用。对注射毒品者的结构性干预措施， 例如针具交换和阿片类激动剂疗法（OAT），已证明在 这些服务障碍低的司法管辖区，导致艾滋病毒发病率惊人下降 疾病负担。我们假设，这些干预措施的独特组合将提供最好的 每种微流行病都是物有所值的，最佳组合将随着时间的推移而变化。 根据潜在的流行趋势和艾滋病毒科学进展情况， 干预研究 我们将展示我们的方法，在美国六个不同的城市设置与不同的 结构条件、药物使用模式和艾滋病毒流行。这个项目是一个创新的 转化研究倡议，将加强监测工作，并增加影响， 艾滋病毒和药物使用障碍干预研究。