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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

基本信息

批准号：
9119314
负责人：
Bohdan Nosyk
金额：
$ 47.72万
依托单位：
SIMON FRASER UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-03-01 至 2021-02-28
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9119314
关键词：
Accounting Acquired Immunodeficiency Syndrome Address Agonist Alcohol or Other Drugs use Annual Reports Area Baltimore Caring Characteristics Cities Consultations Data Data Sources Decision Making Diagnosis Disease Drug usage Economic Models Effectiveness Ensure Epidemic Epidemiology Foundations Frequencies Funding Future Goals HIV HIV risk Health Health Benefit Health Resources Health Services Accessibility Healthcare Systems Human immunodeficiency virus test Incidence Individual Injecting drug user Injection of therapeutic agent Intervention Intervention Studies Knowledge Life Location Los Angeles Modeling Morbidity - disease rate National Institute of Drug Abuse Needle-Exchange Programs New York City North America Observational Study Opioid Output Pattern Performance Play Population Prevention Production Prophylactic treatment Public Health Publications Publishing Reporting Research Research Personnel Resources Risk Risk Behaviors Role Scientific Advances and Accomplishments Secure Services Site Specificity Substance Use Disorder Surveys System Target Populations Testing Time Translational Research United States National Institutes of Health Update Work antiretroviral therapy base burden of illness cost cost effective cost effectiveness design effective intervention flexibility health care delivery improved innovation metropolitan model development mortality national surveillance novel prevent programs public health intervention public health relevance research study response spatiotemporal tool transmission process trend uptake

项目摘要

DESCRIPTION: 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 strategie 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 micro epidemic, 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.