Assessing the Cost-Effectiveness of Interventions Along the HIV Treatment Cascade

 描述(申请人提供)：由于有效的抗逆转录病毒疗法大大减少了病毒载量，因此传播的可能性，级联的最终目标--帮助艾滋病毒携带者(PLWH)达到无法检测到的病毒载量状态--如果我们要将病毒的向前传播减少到可以忽略的水平，同时确保PLWH长寿和多产，是至关重要的。重要的是，需要行为干预来补充和确保生物医学同行在治疗级联过程中的每一步取得成功，无论是帮助艾滋病毒携带者从一种级联状态发展到另一种状态，还是保持相同的级联状态。这一应用的动机是迫切需要一种统一的方法来评估艾滋病毒治疗级联干预措施的艾滋病毒预防效力。目前还不存在这样的方法。需要艾滋病毒预防效果评估以及其他健康效益评估，以估计这些干预措施的成本效益，从而帮助公共卫生决策者为特定目的选择最经济有效的干预措施(例如，将新诊断的人与护理联系起来)，或在级联过程中不同阶段的干预措施之间进行选择。我们建议改进现有方法--基于艾滋病毒传播率--用于估计通过预防性干预避免的性传播艾滋病毒感染的数量，并将其扩展到治疗级联干预，这是评估治疗级联干预的成本效益的必要的第一步。一致性是使成本效益信息有意义的关键。只有使用统一的方法来评估不同干预措施的有效性，才能比较这些分析的结果。我们认为，利用艾滋病毒传播率的概念，可以制定一种统一的方法来评估级联干预措施的艾滋病毒预防效果。治疗级联的每个阶段都与特定的艾滋病毒传播率有关。从级联的一个阶段到下一个阶段的传播率的差异表明，通过帮助艾滋病毒携带者从前一级联阶段进入后一级联阶段的干预措施，单位时间内预防的艾滋病毒感染人数。拟议研究项目的具体目标是：(1)对已发表的灰色文献进行彻底搜索，以获得所需的最新信息，以估计从一种级联状态向另一种状态转变时相关风险的比例降低；(2)根据目标1中获得的经验证据，估计艾滋病毒治疗级联过程中各阶段的平均传播率以及可信的范围；(3)评估两种已证明有效的级联干预措施的成本效益。

 DESCRIPTION (provided by applicant): Because effective antiretroviral therapy substantially reduces viral load, hence the likelihood of transmission, the ultimate goal of the cascade--helping persons living with HIV (PLWH) reach undetectable viral load status--is crucial if we are to reduce forward transmission of the virus to negligible levels and, at the same time, ensure that PLWH live long and productive lives. Importantly, behavioral interventions are needed to complement and ensure the success of their biomedical counterparts at every step along the treatment cascade, whether to help a person living with HIV advance from one state of the cascade to another or to remain at the same cascade state. This application is motivated by the critical need for a uniform methodology for estimating the HIV prevention effectiveness of interventions along the HIV treatment cascade. No such methodology currently exists. HIV prevention effectiveness estimates, along with other health benefit estimates, are needed to estimate the cost-effectiveness of these interventions, and thereby to help public health decision makers select the most economically-efficient intervention for a particular purpose (e.g., linking new-diagnosed persons to care) or to choose between interventions at different stages along the cascade. We propose to refine and extend to treatment cascade interventions an existing method--based on HIV transmission rates--for estimating the number of sexually-transmitted HIV infections averted by preventive interventions, which is a necessary first step toward evaluating the cost-effectiveness of treatment cascade interventions. Uniformity is the key to making cost-effectiveness information meaningful. Only when uniform methods are used to evaluate the effectiveness of disparate interventions can the results of these analyses be compared. We believe a uniform methodology for assessing the HIV prevention effectiveness of cascade- related interventions can be developed using the concept of HIV transmission rates. Each stage of the treatment cascade is associated with a particular HIV transmission rate. The difference in transmission rates from one stage of the cascade to the next one indicates the number of HIV infections prevented, per unit time, by an intervention that helps a person living with HIV advance from the former to the latter cascade stage. The Specific Aims of the proposed research project are: (1) To conduct a thorough search of the published and grey literatures to obtain current information needed to estimate the proportionate reduction in risk associated with the transition from one state of the cascade to another; (2) Based on the empirical evidence obtained in Aim 1, to estimate the average transmission rates for stages along the HIV treatment cascade, along with plausible ranges; and (3) To assess the cost-effectiveness of two cascade interventions of demonstrated effectiveness.