Optimizing HIV Care in Less Developed Countries

项目摘要/摘要 在过去的十年里，在为艾滋病毒感染者提供治疗方面取得了巨大的进步 全世界。更好的抗逆转录病毒治疗(ART)，改进的实验室监测，以及ART的证据 预防导致了开始扭转艾滋病大流行的可能性。同时，有限的 世界各地的资源削弱了国际社会以最佳方式利用这些已证实的资源的能力。 干预措施。在2004年和2008年，NIAID向我们的研究小组提供资金，以开发和扩展 预防艾滋病并发症国际(CEPAC-I)模型的成本效益，计算机模拟 HIV治疗的自然病史、临床管理、结果和成本效益 有限的背景：南非、科特迪瓦和印度。在该项目的最后5年周期中，该合作 在同行评议的期刊上发表了105多篇原创论文。在这方面，我们建议进一步 扩展CEPAC-I模式，以反映艾滋病毒/艾滋病方面的重要事态发展，并处理几个最 艾滋病护理中的紧迫问题。我们有三个具体目标： 具体目标1：审查艾滋病毒护理-艺术启动的最佳方案，监测战略包括 使用护理点测试和方案排序--考虑到南非不同的资源限制， 科特迪瓦、印度和巴西。我们将创建一种新的基于网络的“元模型”结构，以便临床决策者 在其他国家/地区使用CEPAC-I模型的能力。 具体目标2：确定临床疗效和成本的基准，新技术--包括 根除艾滋病毒的长效抗逆转录病毒药物和战略--可能成为可行和具有成本效益的选择。我们会 执行分析以确定在资源有限的情况下新的艾滋病毒治疗方法的性能要求 性价比高。新的建模方法将纳入患者的异质性以及扩展 概率灵敏度分析。 具体目标3：预测临床结果、成本和重大疾病检测和治疗的成本效益 艾滋病毒携带者的共病，包括乙肝和丙型肝炎病毒、结核病和高血压。我们将评估 将艾滋病毒护理与其他常见疾病的筛查和治疗结合起来的成本效益 艾滋病毒携带者。通过新的成本计算和预算影响分析方法，我们将评估以下项目的负担能力 扩大艾滋病毒治疗计划。 聚集在一起的国际公认的多学科研究团队拥有漫长的记录 在美国和国际上传播研究结果，为艾滋病毒护理和指导方针提供信息。要扩展 在项目范围内，我们增加了来自巴西的调查人员，巴西是拉丁美洲艾滋病毒感染最严重的国家。通过 利用团队在过去9年的进展并实现上述目标，拟议的研究 将回答全球艾滋病毒社区面临的许多关键的艾滋病毒临床和政策问题。

Project Summary/Abstract The past decade has seen tremendous progress in the delivery of treatment of HIV-infected individuals worldwide. Better antiretroviral therapy (ART), improved laboratory monitoring, and evidence of ART as prevention have led to the possibility of beginning to reverse the AIDS pandemic. At the same time, limited resources worldwide have tempered the ability of the international community to optimally utilize these proven interventions. In 2004 and in 2008, NIAID awarded our research group funding to develop and expand the Cost-Effectiveness of Preventing AIDS Complications International (CEPAC-I) Model, a computer simulation of the natural history, clinical management, outcomes, and cost-effectiveness of HIV treatment in 3 resource- limited settings: South Africa, C¿te d'lvoire, and India. In the last 5-year cycle of the project, this collaboration produced more than 105 original papers in peer-reviewed journals. In this continuation, we propose to further expand the CEPAC-I Model to reflect important developments in HIV/AIDS, and to address several of the most pressing questions in HIV care. We have three specific aims: Specific Aim 1: To examine the optimal packages of HIV care - ART initiation, monitoring strategies including use of point-of-care tests, and regimen sequencing - given varying resource constraints in South Africa, C¿te d'Ivoire, India, and Brazil. We will create a new web-based 'metamodel' structure to allow clinical policy makers in other countries to access the capabilities of the CEPAC-I Model. Specific Aim 2: To define the benchmarks of clinical efficacy and cost by which new technologies - including long-acting ART and strategies for HIV eradication - may become viable and cost-effective options. We will perform analyses to establish performance requirements for new HIV treatments in resource-limited settings to be cost-effective. Novel modeling methods will incorporate patient heterogeneity as well as expanded probabilistic sensitivity analysis. Specific Aim 3: To project clinical outcomes, cost, and cost-effectiveness of detection and treatment for major co-morbidities in people with HIV, including hepatitis B and C viruses, TB, and hypertension. We will assess the cost-effectiveness of merging HIV care with screening and treatment for other common diseases in people with HIV. With new approaches to costing and budget impact analysis, we will assess the affordability of broadening HIV treatment programs. The assembled internationally-recognized, multidisciplinary research team has a lengthy record of disseminating findings to inform HIV care and guidelines, both in the US and internationally. To expand the project scope, we have added investigators from Brazil, the most HIV-affected country in Latin America. By leveraging the team's progress over the past 9 years and accomplishing the aims above, the proposed studies will answer many critical HIV clinical and policy questions facing the global HIV community.