The CHARMED model: a multimorbidity simulation model for people aging with HIV

CHARMED 模型：针对艾滋病毒老年患者的多发病模拟模型

• 批准号: 10790700
• 负责人: Emily Parker Hyle
• 金额: $ 41.18万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-04-01 至 2026-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10790700
• 关键词: Acquired Immunodeficiency Syndrome; Address; Administrative Supplement; Advocate; Age; Age Years; Aging; Alzheimer' s Disease; Alzheimer' s disease related dementia; American; Area; Award; Cardiovascular Diseases; Caring; Clinical; Clinical Research; Clinical Trials; Cohort Studies; Collaborations; Cost Effectiveness Analysis; Cost of Illness; Data; Dementia; Development; Diagnosis; Disease; Diverse Workforce; Economics; Epidemiology; Etiology; Event; Funding; Future; General Population; Goals; Grant; HIV; HIV/AIDS; Health Care Costs; Heart; High School Student; Impaired cognition; Individual; International; Internships; Intervention; Investigation; Investments; Learning; Life Expectancy; Medicine; Mental Depression; Mental Health; Mentors; Mentorship; Modeling; Morbidity - disease rate; NIH Office of AIDS Research; National Institute on Aging; Neurocognitive; Outcome; Parents; Patients; Persons; Policies; Prevention; Prevention strategy; Public Health; Quality of life; Recording of previous events; Research; Research Methodology; Research Personnel; Research Priority; Research Project Grants; Research Training; Risk; Risk Factors; Students; Time; Training; Treatment Effectiveness; Underserved Population; United States; aged; antiretroviral therapy; care costs; clinical care; clinically relevant; cohort; college; community college; comorbidity; cost; cost effective; cost effectiveness; dementia risk; design; economic outcome; effective therapy; evidence base; experience; high risk; high school; improved; interest; models and simulation; modifiable risk; mortality; mortality risk; multidisciplinary; multiple chronic conditions; novel; parent grant; prevent; programs; supportive environment; synergism; training opportunity; undergraduate student

PROJECT SUMMARY Almost half of all people diagnosed with HIV in the United States are aged 50 or older and are at increased risk for dementia and multimorbidity. Dementia is of major clinical policy concern because it results in inexorable clinical decline and extremely high costs of care. People with HIV are at particularly high risk because they often have major risk factors for the development of traditional etiologies of dementia, such as Alzheimer’s Disease and Alzheimer’s Disease-Related Dementias (AD/ADRD), and they also have a risk of HIV-associated neurocognitive disease (HAND) despite sustained virologic suppression. Depression, cardiovascular disease (CVD), and HIV are known to have potent synergies that contribute to the development of dementia. These comorbidities are modifiable risk factors for dementia that are highly prevalent, known to be undertreated in people with HIV, and likely to be clinically and economically important for prevention and management. The overall goal of this proposal is to provide an evidence-based approach for prioritizing and advocating for interventions to improve the quality of life and reduce morbidity and mortality among people aging with HIV. The benefits of reducing the burden of depression and CVD among people with HIV may currently be underestimated, given that concomitant benefits related to multimorbidity are often not captured due to short durations of observational or trial data. Determining which interventions are most clinically effective and cost- effective is critically important to understand so that people aging with HIV can benefit from strategies to reduce their risk of dementia and multimorbidity as they age. We propose to: 1) develop the Cognitive impairment, HIV, Aging, heaRt, MEntal health, and Dementia (CHARMED) Model, including populating the model with clinical and outcomes data from the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) and nationally-representative cost data; 2) project clinical and economic outcomes of people aging with HIV; and 3) perform cost-effectiveness analyses of targeted interventions to reduce the burden of depression and CVD and to quantify the resultant reduction in dementia and multimorbidity. In this supplement, we outline the development of the HIV/Aging Internship Program: unique, paid internship opportunities for high school and undergraduate students from backgrounds underrepresented in Medicine and Public Health (URiM/URiPH). We propose internships in two areas of focus: 1) Research Methods, and 2) Research Administration. In the Research Methods internship, each student will be paired with an investigator (MD or PhD) with a focused research question. In the Research Administration internship, each student will experience training opportunities with multiple mentors, including: program management, clinical research coordination, and primary investigation. All research projects will be within scope of the funded parent grant; the upfront investment from the one-year supplement will allow for the development of a program that is sustainable for the future.

项目摘要 在美国，几乎一半被诊断出感染艾滋病毒的人年龄在50岁或以上， 治疗痴呆症和多发性硬化症痴呆症是主要的临床政策关注，因为它导致无情的 临床下降和极高的护理费用。艾滋病毒感染者的风险特别高，因为他们 通常具有发展为痴呆症的传统病因的主要风险因素，例如阿尔茨海默氏症 疾病和阿尔茨海默病相关痴呆（AD/ADRD），他们也有艾滋病毒相关的风险， 神经认知疾病（HAND），尽管持续的病毒学抑制。抑郁、心血管疾病 (CVD)，和艾滋病毒已知有强大的协同作用，有助于痴呆症的发展。这些 合并症是痴呆症的可改变风险因素，这些风险因素非常普遍，已知在老年痴呆症中治疗不足， 艾滋病毒感染者，可能在临床和经济上对预防和管理具有重要意义。 该提案的总体目标是提供一种循证方法，以确定优先事项并倡导 采取干预措施，提高艾滋病毒感染者的生活质量，降低发病率和死亡率。 减少艾滋病毒感染者抑郁和心血管疾病负担的好处目前可能是 由于时间短，往往没有捕捉到与多人同时受益的情况， 观察或试验数据的持续时间。确定哪些干预措施在临床上最有效，最具成本- 有效的是至关重要的理解，使艾滋病毒感染者可以受益于战略， 降低老年痴呆症和多发性痴呆症的风险。我们建议：1）发展认知 损伤、HIV、衰老、健康、精神健康和痴呆（CHARMED）模型，包括填充 模型的临床和结果数据来自北美艾滋病队列研究合作组织， 设计（NA-ACCORD）和国家代表性成本数据; 2） 艾滋病毒感染者的老龄化;以及3）对有针对性的干预措施进行成本效益分析，以减少 抑郁症和心血管疾病的负担，并量化由此产生的痴呆症和多发性硬化症的减少。 在本补充中，我们概述了艾滋病毒/老龄化实习计划的发展：独特的，带薪实习 为来自医学背景的高中和本科生提供机会， 公共卫生（URiM/URiPH）。我们建议在两个重点领域实习：1）研究方法，和2） 研究管理。在研究方法实习中，每个学生将与一名研究人员配对 (MD或PhD），并有针对性地提出研究问题。在研究管理实习，每个学生将 与多位导师一起体验培训机会，包括：项目管理，临床研究 协调和初步调查。所有研究项目都将在资助的母基金范围内; 来自一年期补充的前期投资将允许开发一个 可持续的未来。