Cost-effectiveness of cardiovascular disease prevention in HIV care: a systems science approach

项目总结

PROJECT SUMMARY Implementing effective cardiovascular disease (CVD) prevention strategies is critical for reducing the disproportionately greater burden of adverse CVD outcomes facing people living with HIV. Lifestyle modification has been identified as a first-line CVD prevention strategy for the general population and recommended in HIV clinical guidelines. Yet, evidence-based lifestyle modification interventions such as behavioral counseling and referrals to community resources are rarely used in routine HIV care workflows. Addressing this research-to-practice gap requires understanding what processes and structures are needed for effective intervention delivery in HIV care, estimating the costs of interventions, and identifying leverage points in existing systems to integrate interventions. Agent-based modeling (ABM) is a novel systems science approach that can sort through these intervention and system complexities to find the most cost-effective intervention solutions and delivery paths. Thus, the overall goal of this study is to engineer a cost-effective strategy to integrate lifestyle modification interventions in HIV care using ABM. With guidance from experts in HIV (Dr. Ofotokun), CVD (Dr. Ali), ABM (Dr. Bodner), and economic evaluation (Dr. Rask), this goal will be accomplished through the following specific aims: 1) assess the contributions of traditional and HIV-specific risk factors to CVD development in people living with HIV; 2) develop, calibrate, and validate an exploratory ABM that simulates the cost-effectiveness of implementation strategies focused on integrating lifestyle counseling and referral in HIV care; and 3) engineer an optimized strategy for integrating lifestyle counseling and referral in HIV care using ABM and the Multiphase Optimization Strategy. Leveraging these novel computer modeling and engineering methods will allow us to preemptively model intervention solutions and delivery paths to address research-to-practice gaps in HIV care. I am an Assistant Professor of Global Health in the Rollins School of Public Health at Emory University. I have expertise in health intervention research, knowledge translation and epidemiology and possess the ability, experience, motivation, and determination to successfully complete the proposed training and research plans. This K01 award will equip me with new systems science and economic evaluation skills and broaden my understanding and abilities to effect true change in CVD prevention in the HIV population. Because this application aligns with NHLBI's HIV-CVD research priorities and its strategic mission to optimize implementation research, it represents a strong platform on which to build my career as an independent implementation scientist working at the intersection of cardiometabolic diseases and HIV.