Simulation Modeling of Hepatitis B Virus Elimination Strategies in Cote d'Ivoire

项目摘要 B型肝炎病毒（HBV）是世界上导致肝硬化、肝癌和肝脏相关疾病的主要原因。 mortality.世界各地，特别是撒哈拉以南非洲，其负担正在增加。即使 已知撒哈拉以南非洲有数百万人患有慢性B型肝炎感染， 符合条件的患者开始接受治疗。实验室监测的复杂性和成本，肝脏 纤维化评估和抗病毒治疗是阻止大规模应用的一些主要挑战。 治疗 我的目标是确定是否可以简化B型肝炎管理指南， 卫生保健资源的重点是在资源有限的情况下扩大B型肝炎的治疗。 模拟模型是基于证据的工具，越来越多地被调查人员用来 解决诸如此类的复杂问题，通过评估现有的长期临床影响， 作为新的B型肝炎治疗起始策略。我是一名传染病医生， 临床流行病学，模拟建模和成本效益分析的研究背景。我 我有动力扩展我目前的技能，并接受培训，将这些方法应用于 研究撒哈拉以南非洲HBV治疗策略。 指导研究科学家发展奖将使我有机会获得 成为一名独立的临床研究者所需的技能。我需要在（1）模型方面的具体培训 设计和验证;（2）临床和经济结局数据的推导;以及（3）设计和 进行成本效益分析。我设计了一套教学课程， 这些训练目标。我还组建了一个由导师和合作者组成的多学科团队， 方法和/或内容的专业知识谁是致力于我的成功，实现这一目标， 提议在奖励期结束时，我将设计并验证一种新的HBV模拟 模型，用来自撒哈拉以南非洲的临床和经济数据填充模型，并使用 模型进行高影响力的成本效益分析，有可能指导HBV 管理整个大陆。

Project Summary Hepatitis B virus (HBV) is the world's leading cause of cirrhosis, liver cancer, and liver-related mortality. Its burden is increasing around the world, especially in sub-Saharan Africa. Even though millions of people across sub-Saharan Africa are known to have chronic hepatitis B infection, very few eligible patients are started on treatment. The complexity and cost of laboratory monitoring, liver fibrosis assessments, and antiviral treatment are some of the major challenges preventing scale-up of treatment. My goal is to determine whether hepatitis B management guidelines can be simplified so that limited healthcare resources are focused on expanding hepatitis B treatment in resource-limited settings. Simulation models are evidence-based tools that are increasingly being used by investigators to address complex questions such as this, by assessing the long-term clinical impact of existing as well as novel hepatitis B treatment initiation strategies. I am an Infectious Diseases physician with a research background in clinical epidemiology, simulation modeling, and cost-effectiveness analysis. I am motivated to expand on my current skillset and gain training to apply these methodologies to investigate HBV treatment strategies in sub-Saharan Africa. The Mentored Research Scientist Development Award will afford me the opportunity to gain the necessary skills to become an independent clinical investigator. I require specific training in (1) model design and validation; (2) derivation of clinical and economic outcome data; and (3) designing and executing cost-effectiveness analyses. I have designed a didactic curriculum to address each of these training aims. I have also assembled a multi-disciplinary team of mentors and collaborators with methodological and/ or content expertise who are devoted to my success in achieving the aims of this proposal. By the end of the award period, I will have designed and validated a novel HBV simulation model, populated the model with clinical and economic data from sub-Saharan Africa, and used the model conduct a high impact cost-effectiveness analysis that has the potential to guide HBV management across the continent.