Optimizing HIV Care in Less Developed Countries

优化欠发达国家的艾滋病毒护理

• 批准号: 10580906
• 负责人: Kenneth Alan Freedberg
• 金额: $ 105.52万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-01 至 2028-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10580906
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Address; Budgets; Caring; Characteristics; Clinical; Clinical Trials; Computers; Country; Data; Developing Countries; Development; Epidemic; Face; Goals; Guidelines; HIV; HIV Infections; HIV/AIDS; Health; Human immunodeficiency virus test; Incidence; Instruction; International; Intervention; Methods; Modeling; Morbidity - disease rate; NIH Office of AIDS Research; Natural History; Outcome; Persons; Policies; Policy Maker; Population; Prevention; Reduce health disparities; Research; Research Priority; Resource-limited setting; Resources; Testing; antiretroviral therapy; clinical care; clinical implementation; cost; cost effectiveness; experience; high risk population; improved; innovation; insight; mortality; novel; pandemic disease; prevent; preventive intervention; research study; simulation; skills; treatment guidelines; treatment response

Despite major advances in treatment and prevention of HIV infection, the HIV/AIDS pandemic continues to cause tremendous morbidity and mortality. Of the 37.7 million people living with HIV worldwide, only 73% are receiving antiretroviral therapy. In 2020 alone, an estimated 680,000 people died from AIDS-related illness, and nearly two million people are newly infected with HIV each year. The HIV burden is highest in parts of the world that face the additional challenge of highly constrained resources. HIV testing and treatment guidelines have continually evolved; however, assessing the benefits associated with improved testing, more effective antiretroviral therapy, and increasingly effective prevention interventions is difficult. It is unclear which specific strategies and overall approach would be most effective for specific populations, given the critical reality of budget constraints. This competing continuation proposes to expand upon the Cost-Effectiveness of Preventing AIDS Complications International (CEPAC-I) Model, a computer microsimulation of the natural history, management, outcomes, costs, and cost-effectiveness of HIV clinical care. This proposal includes cutting-edge, guideline-informing studies of novel treatments and development of innovative modeling optimization methods to advance the field. There are two specific aims: Specific Aim 1: To expand the CEPAC-I microsimulation to address new clinical policy questions focused on key populations, using data from recent clinical trials and implementation research studies. Specific Aim 2: To expand upon the optimization model and better determine the combination of HIV care interventions that most decreases HIV incidence in countries with different epidemic characteristics and resource constraints. In close alignment with the 2022 research priorities of the NIH Office of AIDS Research, the goals of this proposal include reducing HIV incidence, identifying optimal prevention and treatment responses, and reducing health disparities by improving key population outcomes. The assembled research team has the ideal combination of skills and experience to address critical questions around the cost-effectiveness of new interventions for HIV in high-risk populations. The results will lead to new insights to inform clinicians and policymakers, leading to improved HIV treatment guidelines in multiple resource-limited settings. RELEVANCE (See instructions): People living with HIV/AIDS remain untreated and more become newly infected each year. Many testing, treatment, and prevention methods exist, raising critically important questions about which strategies to employ when, where, and for whom, given varying epidemic features and resource constraints. We will expand the CEPAC-I Model to address questions related to the impact of novel treatment and prevention options and to determine which combinations of interventions will optimize HIV health outcomes globally.

尽管在治疗和预防艾滋病毒感染方面取得了重大进展，但艾滋病毒/艾滋病的流行仍在继续 导致巨大的发病率和死亡率。在全球3770万艾滋病毒感染者中， 73%的人正在接受抗逆转录病毒治疗。仅在2020年，估计就有68万人死于 艾滋病相关疾病，每年有近200万人新感染艾滋病毒。艾滋病毒负担 在面临资源高度有限的额外挑战的世界部分地区，这一比例最高。艾滋病毒 测试和治疗指南不断发展;然而，评估相关的好处， 通过改进的检测、更有效的抗逆转录病毒治疗和日益有效的预防， 干预是困难的。目前尚不清楚哪种具体战略和总体方法最适合 考虑到预算限制的严峻现实， 这一相互竞争的延续建议扩大预防艾滋病的成本效益 复杂性国际（CEPAC-I）模型，一种自然史的计算机微观模拟， 艾滋病毒临床护理的管理、结果、成本和成本效益。该提案包括 尖端的，指导性的新治疗研究和创新模型的开发 优化方法，以推进该领域。有两个具体目标： 具体目标1：扩展CEPAC-I微观模拟，以解决关注的新临床政策问题 使用最近的临床试验和实施研究的数据。 具体目标2：扩展优化模型，更好地确定艾滋病毒护理的组合 在具有不同流行特征的国家， 资源限制。 与NIH艾滋病研究办公室2022年的研究重点密切一致，本研究的目标 建议包括降低艾滋病毒发病率，确定最佳预防和治疗对策， 通过改善关键的人口成果减少健康差距。集合的研究小组有 技能和经验的理想结合，以解决围绕成本效益的关键问题， 针对高危人群的艾滋病毒新干预措施。研究结果将为临床医生提供新的见解 这有助于改进在多种资源有限环境下的艾滋病毒治疗指南。 相关性（参见说明）： 艾滋病毒/艾滋病感染者仍然得不到治疗，而且每年有更多的人成为新感染者。很多测试， 治疗和预防方法的存在，提出了至关重要的问题， 根据不同的流行特征和资源限制，在何时、何地、为谁雇用。我们将 扩展CEPAC-I模型，以解决与新型治疗和预防的影响相关的问题 我们的目标是提供各种备选方案，并确定哪些干预措施组合将优化全球艾滋病毒健康成果。