Adolescent-tailored HIV treatment and prevention strategies in South Africa: projecting clinical benefits and value

南非针对青少年的艾滋病毒治疗和预防策略：预测临床效益和价值

• 批准号: 10707187
• 负责人: Anne Neilan
• 金额: $ 79.28万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-20 至 2027-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10707187
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Acute; Address; Adherence; Adolescence; Adolescent; Adolescent Medicine; Adolescent and Young Adult; Affect; Age; Age Factors; Antibodies; Antigens; Behavior; Budgets; Caring; Cessation of life; Chronic Disease; Clinical; Clinical Research; Clinical Trials; Clinical effectiveness; Collaborations; Cost Effectiveness Analysis; Data; Decision Making; Development; Diagnosis; Disclosure; Economic Models; Enrollment; Epidemic; Epidemiology; Event; Female; Formulation; Foundations; Future; Genotype; Goals; HIV; HIV Infections; HIV/AIDS; Health; Health Services Accessibility; Health behavior; Impulsivity; Incidence; Infection; Injectable; Intervention; Intervention Trial; Life Expectancy; Methods; Modality; Modeling; Monitor; Morbidity - disease rate; National Institute of Child Health and Human Development; Opportunistic Infections; Oral; Outcome; Outcome Assessment; Persons; Pharmaceutical Preparations; Policies; Prevention; Prevention strategy; Public Health; Regimen; Resources; Risk Factors; Risk Taking; Science; Sex Factors; South Africa; South African; Structure; Study models; Subgroup; System; Time; Toxic effect; United States; United States National Institutes of Health; Vaginal Ring; Viral Load result; Vulnerable Populations; Work; adolescent health outcomes; age group; antiretroviral therapy; cohort; cost; cost effective; cost effectiveness; experience; flexibility; health economics; improved; improved outcome; innovation; low and middle-income countries; male; models and simulation; mortality; novel; pill; pre-exposure prophylaxis; prevent; preventive intervention; sex; sexual relationship; social stigma; treatment strategy; uptake; young adult

PROJECT ABSTRACT Globally, HIV-related deaths have decreased 60% from their peak in 2004. Adolescents and young adults (AYA) ages 10 to 24, however, comprise the only age group that has not seen improvements in HIV-related mortality since then. Adolescence is a distinct developmental period, in which risk-taking and impulsive decision-making are normative behaviors. Stigma, disclosure concerns, and medication toxicity impact HIV health behaviors at a time when AYA may also experience their first sexual relationships. Differences in HIV health outcomes by age are partly due to late diagnosis, as well as to challenges in accessing treatment and prevention modalities requiring daily adherence. This problem is particularly acute in South Africa, which has the largest HIV epidemic in the world, with one in three new infections there occurring among AYA. Recent advances in long-acting HIV prevention and treatment formulations that avert the need to take a daily pill hold major promise, particularly for AYA. With support to Dr. Neilan from an NICHD K08 HD094638 (2018-2023) as well as from the Adolescent Medicine for HIV/AIDS Interventions Trials Network U24HD089880 (2017-2022), we developed the Cost-effectiveness of Preventing AIDS Complications-Adolescent and Young Adult (CEPAC- AYA) microsimulation model. We have conducted 12 model-based clinical and cost-effectiveness analyses addressing key questions in AYA HIV prevention, diagnosis, and treatment in the United States. In a new US- South Africa collaboration, we now propose to adapt and expand the structure of this simulation model and assemble necessary data inputs, and then to use the model to identify the most effective and cost-effective approaches and monitoring strategies for the treatment and prevention of HIV among AYA in South Africa. We have three specific aims: Aim 1. Develop new structure within the CEPAC-AYA model and derive data to permit modeling of long-acting ART and PrEP regimens for AYA in South Africa. Aim 2. Evaluate the clinical impact, cost, and cost-effectiveness of new AYA-focused treatment interventions to decrease opportunistic infections and mortality among AYA in South Africa. Aim 3. Assess the clinical impact, cost, and cost-effectiveness of new AYA-focused prevention interventions to reduce HIV incidence among AYA in South Africa. The goal of this proposal is to evaluate context-specific, adolescent-tailored care strategies and to identify the best use of limited resources to improve health outcomes for AYA affected by HIV in South Africa. As new treatments and delivery systems emerge, the model will be poised to inform how to best deploy these resources for this vulnerable population.

项目摘要 在全球范围内，与艾滋病毒有关的死亡人数已从2004年的峰值下降了60%。青少年和年轻人 (AYA)然而，10至24岁是唯一一个艾滋病毒相关疾病没有改善的年龄组 自那以后，死亡。青春期是一个独特的发展时期，在这一时期， 决策是规范的行为。污名，披露问题和药物毒性影响艾滋病毒 健康行为的时候，AYA也可能经历他们的第一次性关系。艾滋病毒的差异 按年龄分列的健康结果部分是由于诊断较晚，以及在获得治疗方面存在挑战， 需要每天坚持的预防模式。这一问题在南非尤为严重， 这是世界上最大的艾滋病毒流行病，三分之一的新感染发生在AYA中。最近 在长效艾滋病毒预防和治疗配方方面取得的进展， 这是一个很大的承诺，特别是对AYA。通过NICHD K 08 HD 094638（2018-2023）向Neilan博士提供支持， 以及来自艾滋病毒/艾滋病干预试验网络U24 HD 089880（2017-2022）的青少年医学， 我们制定了预防艾滋病并发症的成本效益-青少年和年轻人（CEPAC- AYA）微观模拟模型。我们进行了12项基于模型的临床和成本效益分析 解决美国AYA HIV预防、诊断和治疗的关键问题。在新的美国- 南非的合作，我们现在建议调整和扩大这一模拟模型的结构， 收集必要的数据输入，然后使用模型来确定最有效和最具成本效益的 在南非的AYA中治疗和预防艾滋病毒的方法和监测战略。我们 有三个具体目标： 目标1.在CEPAC-AYA模型中开发新结构，并导出数据，以便对 在南非为AYA提供长效ART和PrEP方案。 目标二。评估新的AYA治疗的临床影响、成本和成本效益 采取干预措施，减少南非AYA的机会性感染和死亡率。 目标3。评估新的以AYA为重点的预防的临床影响、成本和成本效益 采取干预措施，降低南非青年人中的艾滋病毒发病率。 该提案的目标是评估针对具体情况的、针对具体情况的护理策略，并确定 最佳利用有限的资源，改善南非艾滋病毒感染者的健康状况。随着新 治疗和输送系统的出现，该模型将随时告知如何最好地部署这些 为这些弱势群体提供资源。