Could long-acting medications facilitate "ending AIDS by 2030" in southern Africa? An allocative efficiency analysis

长效药物能否促进南部非洲“到 2030 年终结艾滋病”？

• 批准号: 10443750
• 负责人: Ronald Scott Braithwaite
• 金额: $ 68.22万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-25 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10443750
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Adherence; Appointment; Arts; Budgets; Caring; Collaborations; Computer Simulation; Continuity of Patient Care; Cost Effectiveness Analysis; Country; Data; Decision Making; Epidemic; Formulation; Funding; Goals; HIV; Health; Health Benefit; Incidence; Individual; Inequality; Infrastructure; Intervention; Link; Male Circumcision; Medical; Mental disorders; Modeling; Morbidity - disease rate; Operations Research; Persons; Pharmaceutical Preparations; Policies; Population; Prevention strategy; Preventive; Province; Published Comment; Publishing; Randomized Controlled Trials; Recording of previous events; Resource Allocation; Resource-limited setting; Resources; Role; South Africa; Southern Africa; Swaziland; Text; Viral; Viral Load result; Zimbabwe; alcohol use disorder; antiretroviral therapy; base; cost; cost effective; demographics; financial incentive; high risk population; improved; intervention cost; mathematical model; medication compliance; mortality; phase III trial; pre-exposure prophylaxis; surveillance data; tool

ABSTRACT/SUMMARY In our 2018 Lancet HIV commentary (“Ending AIDS by 2030: Catchy slogan or sincere goal?"), we note that published surveillance data together with mathematical modeling make it clear that UNAIDS 2030 goals (90% reduction in HIV incidence) are not going to be met with current spending and resource allocation, and UNAIDS 2020 goals (90% of infected are detected, 90% of detected are linked to care, and 90% of linked to care are virally suppressed) are not going to be met by 2020. Existing models suggest a tripling in HIV spending (from $12.8 billion to $40 billion per year) would be necessary to meet these goals, together with an optimizing of that spending. Indeed, without optimization, the necessary spending for that goal would likely top $52 billion per year. To achieve UNAIDS 2030 goals it will be necessary to critically assess the role of all available tools and tailor strategies to maximize their impact. However, current mathematical models omit three important tools in the arsenal for achieving 2030 goals in resource-limited regions: (1) Specific interventions that target the HIV care continuum (in particular specific interventions with randomized controlled-trial evidence include SMS-based text reminders for appointments and/or medications and combination interventions similar to Link4Health [including accelerated medication initiation, SMS-based text reminders, care/information package +/- noncash financial incentive]), (2) targeting interventions to high risk populations (such as those with alcohol use disorders [AUDs] and common mental disorders [CMDs]) that are specifically relevant to a region’s demographics and policy constraints, and (3) alternate timing of the peak of HIV spending (earlier is better because it leads to “getting ahead of the epidemic” but may be less feasible). Accordingly, focusing on the countries of Zimbabwe, eSwatini (formerly known as Swaziland), and South Africa (in particular, the province of KwaZulu Natal [KZN]) because of their disproportionate burden of HIV morbidity and mortality, our proposal uses mathematical modeling to evaluate the allocative efficiency of a wide spectrum of combination HIV prevention strategies to determine: How cost-effective would interventions enhancing ART linkage-adherence-retention (e.g., long acting ART) need to be in order to efficiently constitute combination HIV prevention strategy (Aim 1); How cost-effective would interventions enhancing PrEP linkage- adherence-retention (e.g., long-acting PrEP) need to be in order to efficiently constitute combination HIV prevention strategy (Aim 2); and how cost-effective would interventions enhancing PrEP and ART linkage- adherence-retention need to be in order to efficiently constitute combination HIV prevention strategy (Aim 3).

摘要/总结 在我们2018年的《柳叶刀》艾滋病评论中（“到2030年结束艾滋病：朗朗上口的口号还是真诚的目标？”），我们注意到， 已发表的监测数据和数学模型表明，联合国艾滋病规划署2030年目标（90%） 目前的支出和资源分配将无法满足减少艾滋病毒发病率的需要， 联合国艾滋病规划署2020年目标（90%的感染者被发现，90%的被发现者与护理有关，90%的被发现者与治疗有关） 到2020年将无法实现。现有的模型表明， 为实现这些目标，需要支出（每年128亿至400亿美元）， 优化这些支出。事实上，如果没有优化，实现这一目标的必要支出可能会超过 每年520亿美元。 为了实现联合国艾滋病规划署2030年目标，有必要严格评估所有可用工具的作用， 战略，以最大限度地发挥其影响。然而，目前的数学模型忽略了三个重要的工具， 在资源有限的地区实现2030年目标的武器库：（1）针对艾滋病毒护理的具体干预措施 连续体（特别是具有随机对照试验证据的特定干预措施，包括基于SMS的 预约和/或药物和类似Link 4 Health的组合干预的文本提醒 [包括加速开始用药、基于SMS的文本提醒、护理/信息包+/-非现金 财政奖励]），（2）针对高危人群（如酗酒者）采取干预措施 疾病[AUD]和常见精神障碍[CMD]），特别是与一个地区的 人口统计和政策限制，以及（3）艾滋病毒支出高峰的交替时间（越早越好 因为它导致“领先于流行病”，但可能不太可行）。 因此，以津巴布韦、斯威士兰（前称斯威士兰）和南非为重点， (in特别是夸祖鲁纳塔尔[KZN]省），因为他们的艾滋病毒发病率负担过重 和死亡率，我们的建议使用数学建模来评估广泛的分配效率， 一系列综合艾滋病毒预防战略，以确定：干预措施的成本效益如何 增强ART连接-依从-保持（例如，长效ART），以有效地构成 艾滋病毒预防综合战略（目标1）;加强PrEP联系的干预措施的成本效益如何- 粘附保持（例如，长效PrEP），以有效地构成组合艾滋病毒 预防战略（目标2）;以及加强PrEP和ART联系的干预措施的成本效益如何- 为了有效地制定联合艾滋病预防策略（目标3），需要保持依从性。