Tobacco Use and Cessation, HIV, and TB in South Africa: Clinical and Economic Outcomes

项目总结 全球卫生组织呼吁将烟草控制纳入艾滋病毒和结核病(TB) 回应。烟草使用会恶化艾滋病毒携带者的健康状况，包括增加患结核病的风险 以及心血管疾病和癌症等非传染性疾病的风险。如何最有效地 将烟草控制有效地纳入艾滋病毒和结核病护理仍不清楚；资源限制是必要的 深思熟虑和循证的规划。确定哪些干预措施最有效、最具成本效益， 以及如何结合给药方法以获得最佳结果，对于向临床提供信息至关重要 指导方针。这需要了解各种干预措施的收益和成本，这些成本- 有效性建模是专门设计来解决这些问题的。 这项提案的总体目标是促进以循证方法做出围绕 为低收入和中等收入人群中烟草、艾滋病毒和结核病重叠流行提供综合护理和服务 国家(LMIC)。低收入人群的烟草使用和戒烟行为可能与高收入人群不同 并可能影响干预措施的有效性。在这个提案中，我们将把重点放在南非，一个 烟草、艾滋病毒和结核病疫情频发的国家。我们的研究计划包括：开发集成的 烟草、艾滋病毒和结核病的模拟模型；使用行为、临床和成本数据对模型进行参数化 从南非以社区为基础的人口队列以及其他数据库和研究； 与艾滋病毒感染者使用烟草和戒烟有关的临床和经济后果；以及 对戒烟干预措施进行基于模型的成本效益分析，包括 与其他艾滋病毒和结核病护理干预措施相结合。 这项建议汇集了国际公认的专家，这些领域与 项目，包括与临床政策相关的艾滋病毒和结核病模拟模型、健康行为、烟草治疗 干预措施，以及南非艾滋病毒和共病的流行病学。调查人员和机构 拥有高效合作的历史。这种创新模式将是第一个整合烟草的模式， 艾滋病毒和结核病。这些方法对于解决有关成本的问题非常重要和关键- 将戒烟与艾滋病毒和结核病护理相结合的有效性和政策。模型结构将 能够在其他环境中对戒烟干预措施进行未来分析，建立广泛、持久的 与政策相关的临床和卫生经济分析框架。

PROJECT SUMMARY Global health organizations have called for integrating tobacco control into HIV and tuberculosis (TB) responses. Tobacco use worsens health outcomes of people with HIV, including conferring higher risks of TB and of noncommunicable diseases such as cardiovascular disease and cancer. How to most effectively and efficiently incorporate tobacco control into HIV and TB care remains unclear; resource constraints necessitate thoughtful and evidence-based planning. Determining which interventions are most effective and cost-effective, and how to combine delivery approaches for optimal outcomes, is critically important for informing clinical guidelines. This requires understanding the benefits and costs of various interventions, which cost- effectiveness modeling is specifically designed to address. The overall goal of this proposal is to promote an evidence-based approach to decisions surrounding the integrated care and services for the overlapping tobacco, HIV, and TB epidemics in low- and middle-income countries (LMICs). Tobacco use and cessation behaviors in LMICs may differ from those in high-income countries and can influence the effectiveness of interventions. In this proposal, we will focus on South Africa, a country with colliding tobacco, HIV, and TB epidemics. Our research plan includes: developing an integrated simulation model of tobacco, HIV, and TB; parameterizing the model with behavioral, clinical, and cost data from a community-based population cohort in South Africa and from other databases and studies; projecting clinical and economic outcomes associated with tobacco use and cessation among people with HIV; and conducting model-based cost-effectiveness analysis of tobacco cessation interventions, including those combined with other HIV and TB care interventions. This proposal brings together internationally recognized experts in fields that are complementary for the project, including clinical policy-relevant HIV and TB simulation modeling, health behaviors, tobacco treatment interventions, and epidemiology of HIV and comorbidities in South Africa. The investigators and institutions have a history of highly productive collaboration. The innovative model will be the first to integrate tobacco, HIV, and TB. The methods are highly significant and crucial for addressing questions around cost- effectiveness and policies for integrating tobacco cessation with HIV and TB care. The model structure will enable future analyses of tobacco cessation interventions in other settings, establishing a broad, durable framework for policy-relevant clinical and health economic analyses.