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Addressing Hepatitis C and Hepatocellular Carcinoma: Current and Future Epidemics

应对丙型肝炎和肝细胞癌：当前和未来的流行病

基本信息

批准号：
9040911
负责人：
Holly Hagan
金额：
$ 65.49万
依托单位：
NEW YORK UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-07-01 至 2018-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9040911
关键词：
Accounting Acute Acute Hepatitis C Address Adherence Antiviral Agents Antiviral Therapy Behavioral Budgets Cessation of life Chronic Chronic Hepatitis C Cirrhosis Collaborations Community Practice Community of Practice Computer Simulation Country Data Development Diagnosis Disease Disease Outbreaks Disease Progression Effectiveness Epidemic Epidemiology Future Goals HIV HIV Seropositivity HIV/HCV Harm Reduction Health Health Benefit Health Care Costs Healthcare Systems Hepatitis C Hepatitis C Incidence Hepatitis C Prevalence Hepatitis C Transmission Hepatitis C co-infection Hepatitis C virus Highly Active Antiretroviral Therapy Incidence Income Individual Infection Injecting drug user Injection of therapeutic agent Intervention Knowledge Lead Length Life Expectancy Liver Failure Liver diseases Measures Methods Modeling Natural History Opiates Patients Pharmaceutical Preparations Population Prevalence Prevention Prevention program Preventive Intervention Primary carcinoma of the liver cells Public Health Reporting Research Resistance Resources Risk Series Social Network Source Technology Testing Translating Treatment Protocols Treatment outcome United States National Institutes of Health Virus Diseases base cancer type co-infection comparative effectiveness cost design evidence base health disparity implementation science improved knowledge base men who have sex with men models and simulation multi-component intervention outcome forecast population health prescription opioid abuse prescription opioid misuse prevent programs scale up simulation social media therapy development tool transmission process trend

项目摘要

DESCRIPTION (provided by applicant): Hepatitis C virus (HCV)-related deaths now exceed HIV-related deaths in the US. Throughout the world, HCV is hyperendemic in people who inject drugs (PWID). New outbreaks of acute HCV infection are unfolding in HIV-positive men who have sex with men (MSM) and in 15-24 year olds who have transitioned from abuse of prescription opioids to illicit opiate injection. In patients with chronic HCV infection, 20-25% wil develop liver disease which may manifest as cirrhosis, liver failure or hepatocellular carcinoma (HCC). The prognosis for HCC is extremely poor, and HCV is the chief etiologic agent for this type of cancer. Recent discoveries in HCV prevention and treatment provide a great opportunity to reverse the trend toward increasing rates of HCV, HCV/HIV co-infection, and HCC. This study will use the methods of Implementation Science - research synthesis, mathematical modeling and simulation, and comparative effectiveness analyses - to determine how best to constitute a portfolio of interventions for the prevention and control of HCV and its consequences while taking into limited resources and underlying epidemiologic and social network features account. A dissemination plan will make extensive use of technology, including social media, and guidance from key stakeholders. These are our specific aims: 1. Synthesize evidence characterizing a) transition from misuse of prescription opioids to drug injection, b) HCV epidemiology and prevention for PWID and HIV+ MSM, and c) progression and treatment of HCV disease in these two groups, to derive best estimates to populate our HCV natural history and transmission models. 2. Use agent-based modeling to estimate the effects of scale-up of individual and combined prevention- and treatment-related interventions on HCV transmission and natural history in PWID and HIV+MSM. 3. Determine the combination of interventions for particular budget and epidemiologic scenarios that a) minimizes acute and chronic HCV infections, including HIV/HCV co-infection, b) prevents the greatest number of cases of HCV-related HCC and other serious sequelae, c) maximizes life expectancy and quality- adjusted life expectancy and d) reduces health disparities. 4. In collaboration with our Dissemination Advisory Board, apply an integrated knowledge-exchange approach to providing our target audiences (policymakers, public health and harm reduction practice communities, PWID and HIV+MSM) with the knowledge and tools to implement evidence-based HCV control strategies or reduce personal risk of infection and its consequences. The broad objective of this study is to provide an evidence base to guide allocation of scarce public resources in the US and other countries where HCV is principally transmitted among PWID. This will be accomplished by synthesizing, modeling and translating very recent developments in HCV epidemiology, prevention and treatment into practical tools to optimize population health.

描述（由申请人提供）：在美国，与丙型肝炎病毒 (HCV) 相关的死亡人数现已超过与艾滋病毒相关的死亡人数。在世界各地，丙型肝炎病毒在注射吸毒者 (PWID) 中呈高度流行。新的急性 HCV 感染疫情正在男男性行为者 (MSM) 的 HIV 阳性男性和从滥用处方阿片类药物转向非法注射阿片类药物的 15-24 岁人群中爆发。慢性HCV感染患者中，20-25%会出现肝病，可能表现为肝硬化、肝功能衰竭或肝细胞癌(HCC)。 HCC 的预后极差，HCV 是此类癌症的主要病因。 HCV 预防和治疗方面的最新发现为扭转 HCV、HCV/HIV 混合感染和 HCC 发病率上升的趋势提供了绝佳的机会。本研究将使用实施科学的方法——研究综合、数学建模和模拟以及比较有效性分析——确定如何最好地构建预防和控制丙型肝炎及其后果的干预措施组合，同时考虑有限的资源和潜在的流行病学和社会网络特征。传播计划将广泛利用技术，包括社交媒体以及主要利益相关者的指导。这些是我们的具体目标： 1. 综合表征 a) 从滥用处方阿片类药物到药物注射的转变，b) HCV 流行病学和 PWID 和 HIV+ MSM 的预防，以及 c) 这两组 HCV 疾病的进展和治疗的证据，以获得最佳估计，以填充我们的 HCV 自然史和传播模型。 2. 使用基于主体的模型来估计扩大个体和联合预防和治疗相关干预措施对吸毒者和 HIV+MSM 中 HCV 传播和自然史的影响。 3. 确定针对特定预算和流行病学情况的干预措施组合，a) 最大限度地减少急性和慢性 HCV 感染，包括 HIV/HCV 混合感染，b) 预防最大数量的 HCV 相关 HCC 病例和其他严重后遗症，c) 最大限度地延长预期寿命和质量调整预期寿命，以及 d) 减少健康差距。 4. 与我们的传播咨询委员会合作，采用综合知识交流方法，为我们的目标受众（政策制定者、公共卫生和减少危害实践社区、吸毒者和 HIV+MSM）提供知识和工具，以实施基于证据的 HCV 控制策略或降低个人感染风险及其后果。本研究的总体目标是提供证据基础，以指导美国和丙型肝炎病毒主要在注射吸毒者之间传播的其他国家的稀缺公共资源的分配。这将通过综合、建模 HCV 流行病学、预防和治疗的最新进展并将其转化为优化人口健康的实用工具来实现。