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

项目摘要 实施有效的心血管疾病（CVD）预防策略对于减少 艾滋病毒感染者所面临的心血管疾病不良后果的负担不成比例地更大。生活方式 修改已被确定为一般人群的一线CVD预防策略， 在HIV临床指南中推荐。然而，基于证据的生活方式改变干预措施， 在常规艾滋病毒护理工作流程中很少使用行为咨询和社区资源转诊。 解决这一研究与实践之间的差距需要了解需要哪些流程和结构 在艾滋病护理中提供有效的干预措施，估计干预措施的成本，并确定杠杆点 在现有系统中整合干预措施。基于Agent的建模是一门新兴的系统科学 一种方法，可以通过这些干预和系统的复杂性排序，以找到最具成本效益的 干预解决方案和交付途径。因此，本研究的总体目标是设计一种具有成本效益的 在艾滋病毒护理中使用ABM整合生活方式改变干预措施的战略。在专家的指导下， 艾滋病毒（奥福托昆博士），心血管疾病（阿里博士），ABM（博德纳博士），和经济评估（拉斯克博士），这一目标将是 通过以下具体目标实现：（1）评估传统和艾滋病毒专门 HIV感染者CVD发展的危险因素; 2）开发，校准和验证探索性的 ABM，模拟以整合生活方式为重点的实施战略的成本效益 艾滋病护理中的咨询和转诊;以及3）设计一个整合生活方式咨询的优化策略 在艾滋病毒护理中使用ABM和多阶段优化策略。利用这些新的 计算机建模和工程方法将使我们能够抢先模拟干预解决方案， 提供途径，以解决艾滋病毒护理研究与实践之间的差距。 我是埃默里大学罗林斯公共卫生学院的全球健康助理教授。我 拥有健康干预研究、知识转化和流行病学方面的专业知识， 有能力、经验、动机和决心成功完成拟议的培训和研究 布局这个K 01奖将使我具备新的系统科学和经济评估技能，并扩大我的 理解和能力，以实现真正的变化，心血管疾病的预防艾滋病毒的人口。因为这 应用程序符合NHLBI的HIV-CVD研究优先事项及其战略使命，以优化 实施研究，它代表了一个强大的平台，建立我的职业生涯作为一个独立的 在心脏代谢疾病和艾滋病毒的交叉点工作的执行科学家。

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.