Prospects for hepatitis C elimination in networks of people who inject drugs through improvements in the care continuum

项目摘要/摘要 在美国，注射毒品者(PWID)是丙型肝炎病毒(HCV)感染的主要原因。 改善丙型肝炎病毒护理连续体，特别注意艾滋病毒合并感染的并发症，是至关重要的。 为实现消除丙型肝炎病毒而努力。PWID之间的异质注射和性网络可以显著 影响丙型肝炎病毒和艾滋病病毒的传播和干预结果。尽管对其疗效的实证研究 在直接作用抗病毒(DAA)时代改善丙型肝炎病毒护理连续体的干预措施已经开始 积累起来，仍然缺乏对人口水平的影响和成本效益的了解 这些干预措施为政策制定提供信息。我的长期目标是发展数学和统计学 模拟模型，为与传染病控制相关的卫生政策提供信息。的总体目标 这个应用程序是实现我的长期目标的关键一步，它是开发一种动态代理- 基于丙型肝炎病毒和艾滋病病毒在PWID中传播的网络模型，以确定人口水平的影响 以及改善丙型肝炎病毒护理连续体的干预措施的成本效益。我的中心假设是 针对护理连续体的多个阶段的干预措施，考虑到个人特点， 服务环境和中/宏观层面的环境将在#年对人口层面产生重大影响 减少丙型肝炎病毒和艾滋病毒感染及相关并发症，同时具有成本效益。中环 假设将通过追求三个具体目标来检验：1)确定丙型肝炎病毒护理的社会决定因素 PWID的连续结果，以及在DAA时代改善这些结果的有效干预措施； 2)确定不同干预措施对人口的影响和成本效益，以改善 PWID中的丙型肝炎病毒护理连续体；3)确定不同人群水平影响的决定因素 根据PWID网络的具体特点改善丙型肝炎病毒护理连续体的干预措施。这就做 使用系统回顾和荟萃分析(目标1)实现这些目标，扩展我们的丙型肝炎病毒模型 通过注射网络传播，将性网络和艾滋病毒传播结合在一起(目标2)，并安装 该模型适用于不同的PWID网络，并评估这些网络的影响(目标3)。要完成 研究和发展我的事业，我将获得证据合成，贝叶斯方法方面的研究培训 用于模型校准、卫生经济学和科学交流方面的专业培训， 在卫生政策部的跨学科环境中的领导和协作 斯坦福医学院。预期的结果是一个新的评估复杂的模型平台 改善PWID健康的HIV/丙型肝炎干预策略。这项拟议的研究具有重要意义 因为这些结果将系统地了解PWID和PWID患者中丙型肝炎护理的社会决定因素 关于改善人口状况的干预措施的人口影响和成本效益的基本证据 在不同的PWID人群中提供丙型肝炎病毒护理连续体，为消除丙型肝炎病毒的政策制定提供信息。

Project Summary/Abstract People who inject drugs (PWID) account for the majority of hepatitis C virus (HCV) infections in the U.S. Improving the HCV care continuum, with particular attention to the complication of HIV-coinfection, is critical to achieving HCV elimination. Heterogeneous injection and sexual networks among PWID can significantly affect HCV and HIV transmission and intervention outcomes. Although empirical studies on the efficacy of interventions to improve the HCV care continuum in the direct-acting antiviral (DAA) era have begun to accumulate, there remains a lack of understanding of the population level impact and cost-effectiveness of these interventions to inform policymaking. My long-term goal is to develop mathematical and statistical simulation models to inform health policies relating to infectious disease control. The overall objective for this application, which is a critical step toward attaining my long-term goal, is to develop a dynamic agent- based network model of HCV and HIV transmission among PWID, to determine the population-level impact and cost-effectiveness of interventions to improve the HCV care continuum. My central hypothesis is that interventions that target multiple stages of the care continuum, taking account of individual characteristics, service environment, and meso/macro-level contexts, will have significant population-level impact in decreasing HCV and HIV infections and associated complications while being cost-effective. The central hypothesis will be tested by pursuing three specific aims: 1) Identify social determinants of the HCV care continuum outcomes among PWID, and effective interventions to improve these outcomes in the DAA era; 2) Determine the population-level impact and cost-effectiveness of different interventions to improve the HCV care continuum among PWID; 3) Identify the determinants of differences in population-level impact of interventions to improve the HCV care continuum based on specific features of PWID networks. I will pursue these aims using systematic review and meta-analysis (Aim 1), expanding our model of HCV transmission via injection network to incorporate sexual network and HIV transmission (Aim 2), and fitting the model to different PWID networks and evaluate impact across the networks (Aim 3). To complete the research and advance my career, I will obtain research training in evidence synthesis, Bayesian methods for model calibration, and health economics, and professional training in scientific communication, leadership, and collaboration, in the interdisciplinary environment of the Department of Health Policy at the Stanford School of Medicine. The expected outcome is a novel model platform to evaluate complex HIV/HCV intervention strategies for improving the health of PWID. The proposed research is significant because the results will provide systematic understanding of social determinants of HCV care in PWID and essential evidence on the population-level impact and cost-effectiveness of interventions to improve the HCV care continuum in different PWID populations to inform policymaking on HCV elimination.