Optimizing HIV Care in Less Developed Countries

描述(申请人提供)：在美国和欧洲，艾滋病毒治疗的进步大大降低了与艾滋病相关的发病率和死亡率。然而，尽管药品价格较低，并日益关注全球艾滋病毒流行，但非洲、亚洲和世界各地欠发达国家的严重资源限制限制了抗逆转录病毒治疗和机会性感染预防的可获得性。凭借美国和欧洲在分析和政策影响方面的卓越记录，我们建议以10多年来审查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为基础，将努力扩大到三个欠发达国家。我们提出以下目标： 1.制定全球艾滋病政策模式，这是一个全面和灵活的国家过渡模式，介绍了欠发达国家艾滋病毒疾病的自然历史和治疗情况。 2.分析科特迪瓦、印度和南非这3个国家的艾滋病毒自然病史、治疗效果、费用和生活质量的数据。 3.评估抗逆转录病毒治疗、机会性感染预防和结核病预防的不同策略的临床影响、成本和成本-效果。根据NIAID感兴趣的关键领域，这些目标将有助于开发实用和负担得起的艾滋病毒治疗方法，并为在不同资源环境下合理使用治疗提供信息。这项提案的成果将调查每个国家迫切的艾滋病毒临床和政策问题，结果将提供给提供护理的临床医生和负责制定政策的卫生官员。全球艾滋病政策模型小组已经通过基于模型的成本效益分析影响了美国的艾滋病毒政策，将正式解决这些具有代表性的欠发达国家艾滋病毒护理的资源限制问题。该项目将为临床医生、公共卫生官员和政策制定者阐明艾滋病毒最佳管理的问题，并将提供一个持久的工具，用来解决这些国家和世界其他环境中的关键问题。

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.