Optimizing HIV Care in Less Developed Countries

项目摘要/摘要 尽管在治疗和预防艾滋病毒感染方面取得了重大进展，但艾滋病毒/艾滋病流行病仍在继续。 造成巨大的发病率和死亡率。在全球3670万艾滋病毒携带者中，只有57% 正在接受抗逆转录病毒治疗。2016年有100万人死于艾滋病相关疾病，近 每年有200万人新感染艾滋病毒。艾滋病毒的负担在世界上面临着最高负担的地区 受限制的资源带来的额外挑战。艾滋病毒检测和治疗指南一直在不断 进化，获得了与改进的检测、更有效的抗逆转录病毒治疗和 实验室监测和日益有效的预防干预措施。很明显，大流行可能是 使用现有工具进行更好的控制。然而，目前尚不清楚的是，具体的战略和总体上 考虑到预算限制的重要现实，这种方法对特定人群来说将是最有效的。 这一相互竞争的延续建议扩大预防艾滋病的成本效益 并发症国际(CEPAC-I)模型，一种自然病史、临床的计算机微观模拟 艾滋病毒治疗的管理、结果、成本和成本效益。它将识别测试， 在减少艾滋病毒发病率方面提供最大价值的治疗和预防干预措施 以及延长艾滋病毒携带者的预期寿命。CEPAC-I团队，由领先的艾滋病毒 总部设在美国，主要合作伙伴在南非、科特迪瓦、印度和 巴西。该小组将解决有关艾滋病毒新干预措施的成本效益的关键问题 高危人群。这一结果将使临床医生、政策制定者和艾滋病毒携带者在多个领域 资源受限设置。此外，该提案还包括开发创新模型 确定检测、治疗和预防策略的组合的优化方法 对不同国家的特定人群的影响最大。 这项提议有两个具体目标： 具体目标1：扩展CEPAC-I微观模拟以解决临床政策问题，重点 关于关键人群，使用最近的临床试验和实施研究研究的数据。 具体目标2：开发一种新的优化模型来确定艾滋病毒护理的组合 在疫情不同的国家最大限度地提高存活率或将艾滋病毒发病率降至最低的干预措施 不同的特点和不同的资源限制。 与美国国立卫生研究院艾滋病研究办公室2018年的研究重点密切一致，这一目标 建议包括减少艾滋病毒的发病率，研究下一代疗法，确定最佳方案 预防和治疗对策，并通过改善关键疾病的结果来缩小健康差距 人口。

Project Summary/Abstract Despite major advances in treatment and prevention of HIV infection, the HIV/AIDS pandemic continues to cause tremendous morbidity and mortality. Of the 36.7 million people living with HIV worldwide, only 57% are receiving antiretroviral therapy. One million people died from AIDS-related illness in 2016, and nearly two million are newly infected with HIV each year. The HIV burden is highest in parts of the world that face the additional challenge of constrained resources. HIV testing and treatment guidelines have continually evolved, capturing the benefits associated with improved testing, more effective antiretroviral therapy and lab monitoring, and increasingly effective prevention interventions. It is clear that the pandemic could be better controlled using existing tools. What remains unclear, however, is what specific strategies and overall approach would be most effective for specific populations, given the important reality of budget constraints. This competing continuation proposes to expand upon the Cost-Effectiveness of Preventing AIDS Complications International (CEPAC-I) Model, a computer microsimulation of the natural history, clinical management, outcomes, costs, and cost-effectiveness of HIV treatment. It will identify the testing, treatment, and prevention interventions that provide the most value in terms of decreasing HIV incidence and improving life expectancy with HIV. The CEPAC-I team, made up of a collaboration of leading HIV investigators, is based in the United States, with key collaborators in South Africa, Côte d'lvoire, India, and Brazil. This team will address critical questions around the cost-effectiveness of new interventions for HIV in high-risk populations. The results will inform clinicians, policymakers, and people living with HIV in multiple resource-limited settings. In addition, this proposal includes development of innovative modeling optimization methods to identify the combinations of testing, treatment, and prevention strategies that will have the greatest impact on specific populations in different countries. This proposal has two specific aims: Specific Aim 1: To expand the CEPAC-I microsimulation to address clinical policy questions, focused on key populations, using data from recent clinical trials and implementation research studies. Specific Aim 2: To develop a novel optimization model to determine the combination of HIV care interventions that maximizes survival, or minimizes HIV incidence, in countries with different epidemic characteristics and different resource constraints. In close alignment with the 2018 research priorities of the NIH Office of AIDS Research, the goals of this proposal include reducing the incidence of HIV, investigating next-generation therapies, identifying optimal prevention and treatment responses, and reducing health disparities by improving outcomes in key populations.