Consortium to improve Outcomes in HIV/AIDS, Alcohol, Aging & multi-Substance use

描述（由申请人提供）：在美国，每年有超过50，000名新感染者。艾滋病毒传播持续存在的一个重要原因不是因为缺乏潜在的有效干预措施，而是因为有效的干预措施往往得不到执行。为了解决这个问题，我们提出了一个建议，将比较有效性研究（比较不同干预措施的有效性）和运筹学（比较替代干预措施组合，而不是孤立地比较单一干预措施）结合起来。我们特别强调酒精，因为它是艾滋病毒传播的常见可改变风险因素，也是艾滋病毒进展的常见可改变风险因素。由于不安全的酒精使用经常与多种物质使用（MSU）和抑郁症一起发生，因为它们经常通过类似的途径影响艾滋病毒的传播，我们的建议考虑采取干预措施，同时或按顺序优先处理这些经常交织在一起的行为。我们还考虑了干预设计，可以根据患者的个体特征，如年龄和合并症负担进一步定制。我们寻求在一个基于网络的交互式实验室中实施这种运筹学模型，该实验室旨在通过鼓励建模、观察数据分析和试验设计之间的更大“串扰”来改进研究方法;并通过确定可能特别受益于干预措施的患者群体，或根据特定利益相关者的需求定制结果。

DESCRIPTION (provided by applicant): HIV infects over 50,000 new people each year in the US. An important reason why HIV transmission persists is not because of an absence of potentially effective interventions, but rather because effective interventions are often not implemented. To address this problem, we have created a proposal that integrates comparative effectiveness research (which compares the effectiveness of different interventions) and operations research (which compares alternative portfolios of interventions, rather than comparing single interventions in isolation). We place particular emphasis on alcohol because it is a common modifiable risk factor for HIV transmission and is a common modifiable risk factor for HIV progression. Because unsafe alcohol use often occurs together with multi-substance use (MSU) and depression, because they often act on similar pathways to impact HIV transmission, our proposal considers portfolios of interventions that can address these oft-intertwined behaviors simultaneously or in a sequenced, prioritized progression. We also consider intervention designs that can be further tailored based on individual patient characteristics such as age and comorbidity burden. We seek to implement this operations research model within an interactive web-based laboratory that aims to improve research methods by encouraging greater "cross-talk" between modeling, observational data analysis, and trial design; and by identify patient groups that may particularly benefit from interventions, or tailoring results to the needs of particular stakeholders.