Optimizing HIV Care in Less Developed Countries

描述（由申请人提供）：艾滋病毒疾病治疗的进展使美国和欧洲的艾滋病相关发病率和死亡率大幅下降。然而，尽管药品价格下降，并且更加重视全球艾滋病毒流行病，但非洲、亚洲和世界各地欠发达国家严重的资源限制，限制了抗逆转录病毒治疗和机会性感染预防的提供。我们在美国和欧洲的分析和政策影响方面有着杰出的记录，我们建议利用10多年来研究替代艾滋病毒护理战略的临床影响、成本和成本效益的经验，将努力扩大到三个欠发达国家。我们提出以下目标：

DESCRIPTION (provided by applicant): Advances in the treatment of HIV disease have produced dramatic reductions in AIDS-related morbidity and mortality in the United States and Europe. However, despite lower drug prices and an increased focus on the global HIV epidemic, severe resource constraints in Africa, Asia and less developed countries throughout the world have limited the availability of antiretroviral therapy and opportunistic infection prophylaxis. With a distinguished track record of analysis and policy impact in the United States and Europe, we propose to build on over 10 years of experience examining the clinical impact, cost and cost-effectiveness of alternative HIV care strategies and expand efforts to three less developed countries. We propose the following aims: 1. To develop the Global AIDS Policy Model, a comprehensive and flexible state-transition model of the natural history and treatment of HIV disease in less developed countries. 2. To analyze data on HIV natural history, treatment efficacy, costs, and quality of life in each of 3 countries: Cote d'Ivoire, India, and South Africa. 3. To assess the clinical impact, cost, and cost-effectiveness of different strategies for antiretroviral therapy, opportunistic infection prophylaxis, and tuberculosis preventive therapy. In accordance with key areas of NIAID interest, these aims will help to develop practical and affordable methods for HIV treatment and inform the rational use of therapy in resource-diverse settings. The products of this proposal will investigate pressing HIV clinical and policy questions in each of these countries, and results will be provided to clinicians delivering care and to health officials responsible for shaping policy. Having already influenced HIV policy in the US through model-based cost-effectiveness analysis, the Global AIDS Policy Model team will formally address resource limitations for HIV care in these representative less developed countries. This project will elucidate questions of optimal HIV management for clinicians, public health officials, and policy makers, and it will provide a durable tool with which to address crucial questions in these countries and in other settings worldwide.