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

项目概要/摘要 注射毒品（PWID）的人占美国丙型肝炎病毒（HCV）感染的大多数。 改善丙型肝炎的连续护理，特别是关注艾滋病毒合并感染的并发症，是至关重要的 实现HCV根除。PWID中的异质性注射和性网络可以显著地 影响HCV和HIV的传播和干预结果。虽然关于有效性的实证研究 在直接作用抗病毒药物（DAA）时代，改善HCV护理连续性的干预措施已经开始， 累积起来，仍然缺乏对人口水平的影响和成本效益的了解， 这些干预措施为决策提供信息。我的长期目标是发展数学和统计学 模拟模型，为与传染病控制有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，它是开发一个动态代理- 基于网络模型的HCV和HIV在PWID中的传播，以确定人群水平的影响 和成本效益的干预措施，以改善丙型肝炎护理连续。我的核心假设是 针对护理连续体多个阶段的干预措施，同时考虑到个人特点， 服务环境和中观/宏观层面的背景，将对人口层面产生重大影响， 减少HCV和HIV感染及相关并发症，同时具有成本效益。中央 将通过追求三个具体目标来检验假设：1）确定HCV护理的社会决定因素 PWID之间的连续结果，以及在DAA时代改善这些结果的有效干预措施; 2)确定不同干预措施在人口一级的影响和成本效益， PWID中的HCV护理连续性; 3）确定人群水平影响差异的决定因素， 根据PWID网络的具体特点采取干预措施，改善HCV护理连续性。我会 通过系统回顾和荟萃分析（目标1）实现这些目标，扩展我们的HCV模型 通过注射网络传播，包括性网络和艾滋病毒传播（目标2）， 该模型适用于不同的PWID网络，并评估对整个网络的影响（目标3）。完成 研究和推进我的职业生涯，我将获得证据合成，贝叶斯方法的研究培训， 用于模型校准，卫生经济学，以及科学交流的专业培训， 领导和合作，在卫生政策部的跨学科环境中， 斯坦福大学医学院。预期的结果是一个新的模型平台，以评估复杂的 改善PWID健康的HIV/HCV干预策略。所提出的研究是有意义的 因为研究结果将为PWID中HCV护理的社会决定因素提供系统的理解， 关于改善人口健康的干预措施在人口一级的影响和成本效益的基本证据 不同PWID人群中的HCV护理连续体，为消除HCV的决策提供信息。

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.