Global Health Comparative Effectiveness: A data synthesis method applied to HIV

说明（由申请人提供）：本提案涉及区域区域协定的全球卫生专题领域。对于艾滋病毒和其他全球重要的健康状况，有数百项研究和数十项审查评估预防和治疗干预措施的效果，数据技术性很强，格式不一致。此外，关于疗效的数据（即来自临床试验的最佳条件）往往无法与关于有效性的数据（即来自现实世界的情况）区分开来。这些限制降低了干预评估研究对政策和项目发展的价值。本研究的目的是开发和实施创新的方法，将艾滋病毒预防和治疗干预措施对健康的益处的现有数据转化为全球卫生艾滋病毒政策和计划的准确和透明的经验基础，从而增加经验研究对现实世界实施的价值和使用。具体目标是：(1)评估有关艾滋病毒预防和治疗干预措施的有效性和有效性的证据，包括制定一个有效性评分，该评分描述了研究在多大程度上反映了现实世界的实施情况，并评估干预效益的大小如何随该评分而变化；(2)结合有效性和疾病负担数据，将大规模实施的特定干预措施的效果转化为估计减少的人口水平疾病负担；(3)结合效果、负担减少和成本，计算干预措施的成本效益；(4)通过基于网络的资源，使决策者和其他技术和非技术最终用户能够轻松获取目标1至3中的发现。这项工作的影响可能是巨大的。2015年，艾滋病毒预计将导致每年1.28亿残疾调整生命年（DALYs）死亡，成为发展中国家最大的负担。因此，由于我们的综合和分析，编程效率方面的小幅提高可能会带来巨大的健康益处。此外，我们的方法可应用于其他全球卫生状况。

DESCRIPTION (provided by applicant): This proposal addresses the RFA thematic area of global health. For HIV and other globally important health conditions, there are hundreds of studies and dozens of reviews assessing the effects of prevention and treatment interventions, with data that is highly technical and presented in inconsistent formats. In addition, data on efficacy (i.e., from the optimal conditions of clinical trials) is often not distinguished from data on effectiveness (i.e., from real-world circumstances). These limitations reduce the value of intervention assessment studies for the development of policies and programs. The goal of this study is to develop and implement innovative approaches to translate existing data on the health benefits of HIV prevention and treatment interventions into an accurate and transparent empirical basis for global health HIV policies and programs, thus increasing the value and use of empirical studies for real-world implementation. The specific aims are to: (1) assess evidence regarding the efficacy and effectiveness of prevention and treatment interventions for HIV, including the development of an effectiveness score that describes how well studies reflect real-world implementation, and an assessment of how the magnitude of intervention benefit varies with this score; (2) by combining data on effectiveness and disease burden, translate the effect of specified interventions implemented at large scale to estimate reduced population-level disease burden; (3) incorporating effectiveness, burden reduction, and cost, calculate the cost-effectiveness of sets of interventions; and, (4) make findings in Aims 1 to 3 easily accessible to decision-makers and other technical and non-technical end users through a web-based resource. The impact of this work is potentially large. HIV is expected to account for 128 million disability-adjusted life years (DALYs) per year in 2015, the largest burden in the developing world. Thus, small gains in programming efficiency as a result of our syntheses and analyses could have large health benefits. In addition, our methods can be applied to other global health conditions. PUBLIC HEALTH RELEVANCE: There are thousands of studies measuring the effects of HIV prevention and treatment interventions, yielding data that are highly technical, presented in inconsistent formats, and usually inaccessible to policy-makers. This project will use innovative and rigorous methods to develop clear and accurate data on effectiveness, potential reduction in HIV disease burden, and costs for combinations of HIV interventions. The analysis will provide valuable information and tools to inform global HIV policies and programs.