Optimizing HIV Care in Less Developed Countries

描述（由申请人提供）：在过去的十年中，全世界在向艾滋病毒感染者提供治疗方面取得了巨大进展。更好的抗逆转录病毒疗法、更好的实验室监测以及抗逆转录病毒疗法作为预防手段的证据，使艾滋病大流行有可能开始逆转。与此同时，全球有限的资源削弱了国际社会最佳利用这些已被证明行之有效的干预措施的能力。2004年和2008年，NIAID向我们的研究小组提供了资金，用于开发和扩展预防艾滋病并发症国际成本效益模型（CEPAC-I），这是一种计算机模拟自然历史、临床管理、结果和艾滋病毒治疗在三个资源有限的国家（南非、科特迪瓦和印度）的成本效益。在项目的最后5年周期中，这种合作产生了超过

DESCRIPTION (provided by applicant): 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.